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ORAL MANIFESTATION OF ULCERS BY IMMUNOSSUPRESSION: A CASE SERIES
ABSTRACTS
e110
THAYNA MELO DE LIMA MARAIS, ERIKA GRAF PEDROSO, ALAN ROGER DOS SANTOS-SILVA, OSLEI PAES DE ALMEIDA and, MARCIO AJUDARTE LOPES Spindle cell carcinoma (SpCC) is considered a rare high malignant variant of squamous cell carcinoma (SCC) occurring predominantly in the upper aerodigestive tract. Lane tumor is a synonym for SpCC and is an uncommon poorly differentiated type of SCC comprising up to 3%. SpCC most commonly occurs in the sixth to seventh decades of life and usually affects men. A 66-year-old white patient was presenting an extensive ulcerated lesion affecting the lower lip with infiltrative fibroelastic consistency, local symptomatology, and 1 year of evolution. An incisional biopsy was performed, and the histopathologic findings were compatible with SpCC. Immunohistochemistry was also performed, which showed positivity for S-100. The association of clinical and histopathologic characteristics and the immunohistochemical analysis led to the diagnosis of SpCC. The patient was guided and referred to a head and neck surgeon for treatment.
CHERUBISM: IMPORTANCE OF REGULAR FOLLOW-UP AND MAINTENANCE OF HIGH-STANDARD ORAL CARE. ALESSANDRA MEIRELLES MASSAUD DE PINHO, ANDREIA MIRANDA ROCHA, LUIZ FERNANDO DELUIZ, SIMONE MACEDO AMARAL, HENRIQUE MARTINS DA SILVEIRA, AGUIDA MARIA MENEZES AGUIAR MIRANDA and, FABIO RAMOA PIRES Cherubism is a rare developmental condition of the gnathic bones that is usually inherited as an autosomal dominant trait with variable expressivity. An 11-year-old girl was referred because of an asymptomatic bilateral facial progressive swelling. Medical history was noncontributory. Locoregional physical examination revealed a bilateral firm swelling in the cheek and retromolar area covered by normal skin and normal oral mucosa, respectively. Panoramic radiograph and cone beam computed tomography scans showed bilateral extensive multilocular lesions in the mandibular posterior areas. Clinical diagnosis was cherubism, and histologic analysis of the specimen obtained by an incisional biopsy confirmed this hypothesis. The patient has been followed up and is under orthodontic treatment with satisfactory results.
ERUPTION MESENCHYMAL CALCIFIED HAMARTOMA: A CASE REPORT. ANA LUIZA ^ A ROZA, THAYSE BRANDI, OLIVEIRA CORRE KELLY TAMBASCO BEZERRA, NATHALIE HENRIQUES SILVA CANEDO, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, MICHELLE AGOSTINI and, MARIO JOSE e ROMANACH Eruption mesenchymal calcified hamartoma (formerly known as eruption sequestrum) is an uncommon proliferation of odontogenic calcified structures, usually observed in the opercula of lower first molars of delayed eruption. A 6-year-old Brazilian girl was seen for routine dental examination. A fragment of hard whitish tissue was observed in the gingiva overlying the erupting lower first permanent molar, which showed radiographic appearance of a 0.5-cm faint round radiopacity above and separated from the occlusal surface of the related molar. The patient was
OOOO January 2020 submitted to an excisional biopsy, and gross examination showed a hardened whitish fragment surrounded by gingival mucosa. Microscopically, limited proliferation of cords of odontogenic epithelium was observed in association with small concentric basophilic calcifications and few large, round osteodentin and pulp-like structures. There were numerous inflammatory cells and small blood vessels in the surrounding connective tissue. The final diagnosis was eruption mesenchymal calcified hamartoma.
DESMOID-TYPE FIBROMATOSIS OF THE BUCCAL MUCOSA: A CASE REPORT. ANTONIO ERNANDO CARLOS FERREIRA JUNIOR, CAMILA CARVALHO DE OLIVEIRA, FABRICIO SILVIA WALTER DE DE LAMARE RAMOS, ANDREA AGUIAR, FABRICIO BITU SOUSA, MARIO ROGERIO LIMA MOTA and, ANA PAULA NEGREIROS NUNES ALVES Desmoid-type fibromatosis is a rare benign mesenchymal lesion that originates from musculoaponeurotic structures and rarely occurs in the head and neck region. The 32-year-old male patient was referred for evaluation of a submucosal lesion located in the left buccal mucosa, which was hardened, was painless, and had 3 months of evolution. Ultrasonography showed a well-defined, anechoic, and hypovascular mass. The histopathologic analysis showed proliferation of elongated, spindle-shaped cells of uniform appearance exhibiting condensed chromatin and eosinophilic cytoplasm with imprecise limits, sometimes with fasciculate pattern, associated with areas of prominent fibrosis with thick bundles of collagen. The proliferation produces dissociation and degeneration of muscle fibers. Immunohistochemical reaction revealed, in tumor cells, negativity for protein S100 and CD34 besides immunoexpression focal positive for a actin and b catenin. The cells strongly expressed vimentin. Morphologic and immunohistochemical findings were compatible with desmoid type fibromatosis. The patient is under clinical follow-up of 8 months without relapse.
ORAL MANIFESTATION OF ULCERS BY IMMUNOSSUPRESSION: A CASE SERIES. TIAGO LUIS HERPICH, MICHELLE ROXO GONCALVES, ¸ RENATA ZIEGER, MARINA GIRARDI SCHUEIGART, ANDRESSA CRISTINA HASHIGUCHI DE ALMEIDA, CAROLINA DUMMEL and, MARCO ^ ANTONIO TREVIZANI MARTINS Immunosuppression is defined as the reduction of activity or efficiency of the immune system. Neutropenia is the decrease in the number of neutrophils, which can cause ulcers in the oral cavity. The first patient, a 32-year-old HIV-positive patient with tuberculosis, presented ulcers on the upper and lower labial mucosa, bilateral buccal mucosa, and tongue. The second, a 47year-old HIV-positive patient, had ulcers on the tongue and buccal mucosa. The third, a 17-year-old patient with osteosarcoma of the femur, metastasis in lung, lymph nodes, and tibia who is undergoing chemotherapy, had ulcers on bilateral buccal mucosa. In all 3 patients, incisional biopsy, histopathologic examination (chronic inflammatory infiltrate), and culture (negative for alcohol-acid resistant bacili, herpes, and cytomegalovirus) were performed. By exclusion, it was classified as ulcers by immunosuppression. The treatment of the patients occurred with
OOOO Volume 129, Number 1 normalization of the immunologic problems and mouthwashes with chlorhexidine 0.12% and laser therapy. There was complete healing of the ulcers.
UNUSUAL OCCURRENCE OF CLEAR CELLS IN ODONTOGENIC FIBROMA: A CASE STUDY WITH IMMUNOHISTOCHEMICAL ANALYSIS. PATRICIA GUERRA PEIXE GONCALVES, ¸ RODRIGO PORPINO MAFRA, HELLEN BANDEIRA DE PONTES SANTOS, LARISSA SANTOS AMARAL ROLIM, PATRICIA DARVIN GOMES PARENTE, LELIA BATISTA e DE SOUZA and, LEAO PEREIRA PINTO Odontogenic fibroma (OF) is an uncommon benign neoplasm with varying histopathologic features. We report a case of a 44-year-old female patient presenting a painful lesion in the maxilla with 8 months of evolution. Intraoral inspection showed a sessile, firm swelling measuring about 2 cm in diameter. Panoramic radiograph evidenced a well-defined radiolucency between teeth 16 and 18. Incisional biopsy was performed. Histopathologic analysis revealed a benign neoplasm characterized by proliferation of stellate ectomesenchymal cells associated with intense collagen deposition. Numerous islands and cords of odontogenic epithelium with a predominance of clear cells were evidenced. Epithelial cells showed immunopositivity for CK19, AE1/AE3, and Ki-67 but no immunopositivity for a smooth muscle actin, S-100, or CD68. Histopathologic diagnosis was OF, and the patient was referred for tumor excision. This is a case of particular interest because of the unusual occurrence of clear cells in the epithelial component of OF, which may lead to diagnostic difficulties.
TUBERCULOSIS OF THE ORAL CAVITY: CASE REPORT. AMANDA SILVA DE ALMEIDA LIMA, THIAGO MOREIRA PESSOA, GERALDO OLIVEIRA SILVA JUNIOR, MARILIA HEFFER ^ PIRES CANTISANO and, FABIO RAMOA Tuberculosis is a serious public health problem that, despite its decreasing incidence rate, still presents high mortality. It is a bacterial infection transmitted through the air, caused by the Mycobacterium tuberculosis bacterium that affects the lungs, and can remain latent or evolve to the disease state, spreading later to other parts of the body. This study exemplifies the case of a 57-year-old white man, a bookseller, smoker, and resident in an area without basic sanitation, who had white plaques mixed with erythematous areas in oropharynx with a 5-month evolution, difficulty in swallowing, and episodes of night fever. Histopathologically, a granulomatous inflammatory process was observed showing areas of necrosis and pseudoepitheliomatous hyperplasia. The periodic acid Schiff and Grocott stains were negative, and the Ziehl-Nielsen staining showed Epstein-Barr presence. The patient was referred for treatment.
UNICYSTIC AMELOBLASTOMA: A CASE REPORT WITH EMPHASIS ON THE RELATIONSHIP OF THE TUMOR WITH ADJACENT TEETH. ANDREIA MIRANDA ROCHA, CAROLINA FREDES ACEVEDO, FABIO RAMOA PIRES, JULIANA DE NORONHA SANTOS NETTO, SIMONE MACEDO AMARAL, HENRIQUE MARTINS DA SILVEIRA and, AGUIDA MARIA MENEZES AGUIAR MIRANDA
ABSTRACTS
e111
A 58-year-old woman was referred because of a swelling in the anterior mandible associated with displacement of teeth and discomfort in the area. Medical history showed hypertension. Clinical examination revealed a 2.0-cm bluish swelling in the alveolar mucosa of the anterior mandible with hard consistency. Panoramic and periapical radiographs revealed a 3.0-cm well-defined unilocular radiolucent lesion in the anterior mandible. Vitality tests showed that some teeth associated with the lesion presented normal results, while others showed negative responses. Clinical diagnoses were glandular odontogenic cyst and ameloblastoma, and an incisional biopsy was performed. Histologic diagnosis was compatible with unicystic ameloblastoma, and the patient was submitted to a conservative surgical removal of the lesion. Final diagnosis confirmed unicystic ameloblastoma, and the patient is under clinical and radiologic follow-up. Histologic analysis showed different relationships of the tumor with the roots of adjacent teeth.
OROFACIAL FOREIGN BODY REACTION TO COSMETIC MATERIAL: REPORT OF 3 NEW CASES. NATALIA MELCOP, EMANUEL ^ A ROZA, ALINE MENDES, ANA LUIZA OLIVEIRA CORRE e ^ A ABRAHAO, CORRE MICHELLE AGOSTINI, BRUNO AUGUSTO BENEVENUTO DE ANDRADE and, MARIO e JOSE ROMANACH Orofacial foreign body reactions are adverse effects to cosmetic fillers that are often used for esthetic purpose. Case 1 involved a 76-year-old woman with a painless swelling in the upper lip lasting 1 year. Case 2 involved a 53-year-old woman presenting multiple painless normal-colored nodules of unknown duration located in the lower lip mucosa. Case 3 involved a 77year-old woman with a painless nodule in the right buccal mucosa of unknown duration. All patients admitted having undergone a cosmetic procedure in the past. Microscopically, all cases showed variable-sized empty microcysts, surrounded by a mixture of histiocytes, collagen bundles, multinucleated giant cells, and inflammatory cells. Patients are under follow-up after treatment that consisted of surgical excision of the material. Foreign body reactions to cosmetic fillers are uncommon in the orofacial region.
MULTIPLE HEMANGIOMAS WITH FORMATION OF PHLEBOLITH: CASE REPORT. GILBERTO MARCUCCI, VINICIUS PIOLI e ZANETIM, LEONARDO BRAUN GALVAO MAXIMO DIAS and, MARCELO MARCUCCI Lesions of vascular nature often suffer dystrophic calcification inside, called phleboliths, and are represented by radiopaque areas sometimes forming concentric circles. A white 30-year-old male patient complained of "purple growths in mouth and face for several years." Medical records were not contributory. During physical examination, we found purplish growths with discoloration in the labial mucosa and cutaneous region. During intraoral examination, we observed lesions on the lip mucosa, purplish in the commissures, and purplish nodules on the floor of the mouth and lingual side. Purplish stains are observed in retromolar trigone and lingual dorsum regions. With a diagnosis of hemangiomas, occlusal x-ray was performed, which revealed radiopacities (phleboliths) in the mouth floor corresponding to the vascular lesions of the region. We referred him for a systemic evaluation by a vascular surgeon. Phleboliths can be easily confused with sialoliths, therefore requiring careful consideration by the clinician.
e110
THAYNA MELO DE LIMA MARAIS, ERIKA GRAF PEDROSO, ALAN ROGER DOS SANTOS-SILVA, OSLEI PAES DE ALMEIDA and, MARCIO AJUDARTE LOPES Spindle cell carcinoma (SpCC) is considered a rare high malignant variant of squamous cell carcinoma (SCC) occurring predominantly in the upper aerodigestive tract. Lane tumor is a synonym for SpCC and is an uncommon poorly differentiated type of SCC comprising up to 3%. SpCC most commonly occurs in the sixth to seventh decades of life and usually affects men. A 66-year-old white patient was presenting an extensive ulcerated lesion affecting the lower lip with infiltrative fibroelastic consistency, local symptomatology, and 1 year of evolution. An incisional biopsy was performed, and the histopathologic findings were compatible with SpCC. Immunohistochemistry was also performed, which showed positivity for S-100. The association of clinical and histopathologic characteristics and the immunohistochemical analysis led to the diagnosis of SpCC. The patient was guided and referred to a head and neck surgeon for treatment.
CHERUBISM: IMPORTANCE OF REGULAR FOLLOW-UP AND MAINTENANCE OF HIGH-STANDARD ORAL CARE. ALESSANDRA MEIRELLES MASSAUD DE PINHO, ANDREIA MIRANDA ROCHA, LUIZ FERNANDO DELUIZ, SIMONE MACEDO AMARAL, HENRIQUE MARTINS DA SILVEIRA, AGUIDA MARIA MENEZES AGUIAR MIRANDA and, FABIO RAMOA PIRES Cherubism is a rare developmental condition of the gnathic bones that is usually inherited as an autosomal dominant trait with variable expressivity. An 11-year-old girl was referred because of an asymptomatic bilateral facial progressive swelling. Medical history was noncontributory. Locoregional physical examination revealed a bilateral firm swelling in the cheek and retromolar area covered by normal skin and normal oral mucosa, respectively. Panoramic radiograph and cone beam computed tomography scans showed bilateral extensive multilocular lesions in the mandibular posterior areas. Clinical diagnosis was cherubism, and histologic analysis of the specimen obtained by an incisional biopsy confirmed this hypothesis. The patient has been followed up and is under orthodontic treatment with satisfactory results.
ERUPTION MESENCHYMAL CALCIFIED HAMARTOMA: A CASE REPORT. ANA LUIZA ^ A ROZA, THAYSE BRANDI, OLIVEIRA CORRE KELLY TAMBASCO BEZERRA, NATHALIE HENRIQUES SILVA CANEDO, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, MICHELLE AGOSTINI and, MARIO JOSE e ROMANACH Eruption mesenchymal calcified hamartoma (formerly known as eruption sequestrum) is an uncommon proliferation of odontogenic calcified structures, usually observed in the opercula of lower first molars of delayed eruption. A 6-year-old Brazilian girl was seen for routine dental examination. A fragment of hard whitish tissue was observed in the gingiva overlying the erupting lower first permanent molar, which showed radiographic appearance of a 0.5-cm faint round radiopacity above and separated from the occlusal surface of the related molar. The patient was
OOOO January 2020 submitted to an excisional biopsy, and gross examination showed a hardened whitish fragment surrounded by gingival mucosa. Microscopically, limited proliferation of cords of odontogenic epithelium was observed in association with small concentric basophilic calcifications and few large, round osteodentin and pulp-like structures. There were numerous inflammatory cells and small blood vessels in the surrounding connective tissue. The final diagnosis was eruption mesenchymal calcified hamartoma.
DESMOID-TYPE FIBROMATOSIS OF THE BUCCAL MUCOSA: A CASE REPORT. ANTONIO ERNANDO CARLOS FERREIRA JUNIOR, CAMILA CARVALHO DE OLIVEIRA, FABRICIO SILVIA WALTER DE DE LAMARE RAMOS, ANDREA AGUIAR, FABRICIO BITU SOUSA, MARIO ROGERIO LIMA MOTA and, ANA PAULA NEGREIROS NUNES ALVES Desmoid-type fibromatosis is a rare benign mesenchymal lesion that originates from musculoaponeurotic structures and rarely occurs in the head and neck region. The 32-year-old male patient was referred for evaluation of a submucosal lesion located in the left buccal mucosa, which was hardened, was painless, and had 3 months of evolution. Ultrasonography showed a well-defined, anechoic, and hypovascular mass. The histopathologic analysis showed proliferation of elongated, spindle-shaped cells of uniform appearance exhibiting condensed chromatin and eosinophilic cytoplasm with imprecise limits, sometimes with fasciculate pattern, associated with areas of prominent fibrosis with thick bundles of collagen. The proliferation produces dissociation and degeneration of muscle fibers. Immunohistochemical reaction revealed, in tumor cells, negativity for protein S100 and CD34 besides immunoexpression focal positive for a actin and b catenin. The cells strongly expressed vimentin. Morphologic and immunohistochemical findings were compatible with desmoid type fibromatosis. The patient is under clinical follow-up of 8 months without relapse.
ORAL MANIFESTATION OF ULCERS BY IMMUNOSSUPRESSION: A CASE SERIES. TIAGO LUIS HERPICH, MICHELLE ROXO GONCALVES, ¸ RENATA ZIEGER, MARINA GIRARDI SCHUEIGART, ANDRESSA CRISTINA HASHIGUCHI DE ALMEIDA, CAROLINA DUMMEL and, MARCO ^ ANTONIO TREVIZANI MARTINS Immunosuppression is defined as the reduction of activity or efficiency of the immune system. Neutropenia is the decrease in the number of neutrophils, which can cause ulcers in the oral cavity. The first patient, a 32-year-old HIV-positive patient with tuberculosis, presented ulcers on the upper and lower labial mucosa, bilateral buccal mucosa, and tongue. The second, a 47year-old HIV-positive patient, had ulcers on the tongue and buccal mucosa. The third, a 17-year-old patient with osteosarcoma of the femur, metastasis in lung, lymph nodes, and tibia who is undergoing chemotherapy, had ulcers on bilateral buccal mucosa. In all 3 patients, incisional biopsy, histopathologic examination (chronic inflammatory infiltrate), and culture (negative for alcohol-acid resistant bacili, herpes, and cytomegalovirus) were performed. By exclusion, it was classified as ulcers by immunosuppression. The treatment of the patients occurred with
OOOO Volume 129, Number 1 normalization of the immunologic problems and mouthwashes with chlorhexidine 0.12% and laser therapy. There was complete healing of the ulcers.
UNUSUAL OCCURRENCE OF CLEAR CELLS IN ODONTOGENIC FIBROMA: A CASE STUDY WITH IMMUNOHISTOCHEMICAL ANALYSIS. PATRICIA GUERRA PEIXE GONCALVES, ¸ RODRIGO PORPINO MAFRA, HELLEN BANDEIRA DE PONTES SANTOS, LARISSA SANTOS AMARAL ROLIM, PATRICIA DARVIN GOMES PARENTE, LELIA BATISTA e DE SOUZA and, LEAO PEREIRA PINTO Odontogenic fibroma (OF) is an uncommon benign neoplasm with varying histopathologic features. We report a case of a 44-year-old female patient presenting a painful lesion in the maxilla with 8 months of evolution. Intraoral inspection showed a sessile, firm swelling measuring about 2 cm in diameter. Panoramic radiograph evidenced a well-defined radiolucency between teeth 16 and 18. Incisional biopsy was performed. Histopathologic analysis revealed a benign neoplasm characterized by proliferation of stellate ectomesenchymal cells associated with intense collagen deposition. Numerous islands and cords of odontogenic epithelium with a predominance of clear cells were evidenced. Epithelial cells showed immunopositivity for CK19, AE1/AE3, and Ki-67 but no immunopositivity for a smooth muscle actin, S-100, or CD68. Histopathologic diagnosis was OF, and the patient was referred for tumor excision. This is a case of particular interest because of the unusual occurrence of clear cells in the epithelial component of OF, which may lead to diagnostic difficulties.
TUBERCULOSIS OF THE ORAL CAVITY: CASE REPORT. AMANDA SILVA DE ALMEIDA LIMA, THIAGO MOREIRA PESSOA, GERALDO OLIVEIRA SILVA JUNIOR, MARILIA HEFFER ^ PIRES CANTISANO and, FABIO RAMOA Tuberculosis is a serious public health problem that, despite its decreasing incidence rate, still presents high mortality. It is a bacterial infection transmitted through the air, caused by the Mycobacterium tuberculosis bacterium that affects the lungs, and can remain latent or evolve to the disease state, spreading later to other parts of the body. This study exemplifies the case of a 57-year-old white man, a bookseller, smoker, and resident in an area without basic sanitation, who had white plaques mixed with erythematous areas in oropharynx with a 5-month evolution, difficulty in swallowing, and episodes of night fever. Histopathologically, a granulomatous inflammatory process was observed showing areas of necrosis and pseudoepitheliomatous hyperplasia. The periodic acid Schiff and Grocott stains were negative, and the Ziehl-Nielsen staining showed Epstein-Barr presence. The patient was referred for treatment.
UNICYSTIC AMELOBLASTOMA: A CASE REPORT WITH EMPHASIS ON THE RELATIONSHIP OF THE TUMOR WITH ADJACENT TEETH. ANDREIA MIRANDA ROCHA, CAROLINA FREDES ACEVEDO, FABIO RAMOA PIRES, JULIANA DE NORONHA SANTOS NETTO, SIMONE MACEDO AMARAL, HENRIQUE MARTINS DA SILVEIRA and, AGUIDA MARIA MENEZES AGUIAR MIRANDA
ABSTRACTS
e111
A 58-year-old woman was referred because of a swelling in the anterior mandible associated with displacement of teeth and discomfort in the area. Medical history showed hypertension. Clinical examination revealed a 2.0-cm bluish swelling in the alveolar mucosa of the anterior mandible with hard consistency. Panoramic and periapical radiographs revealed a 3.0-cm well-defined unilocular radiolucent lesion in the anterior mandible. Vitality tests showed that some teeth associated with the lesion presented normal results, while others showed negative responses. Clinical diagnoses were glandular odontogenic cyst and ameloblastoma, and an incisional biopsy was performed. Histologic diagnosis was compatible with unicystic ameloblastoma, and the patient was submitted to a conservative surgical removal of the lesion. Final diagnosis confirmed unicystic ameloblastoma, and the patient is under clinical and radiologic follow-up. Histologic analysis showed different relationships of the tumor with the roots of adjacent teeth.
OROFACIAL FOREIGN BODY REACTION TO COSMETIC MATERIAL: REPORT OF 3 NEW CASES. NATALIA MELCOP, EMANUEL ^ A ROZA, ALINE MENDES, ANA LUIZA OLIVEIRA CORRE e ^ A ABRAHAO, CORRE MICHELLE AGOSTINI, BRUNO AUGUSTO BENEVENUTO DE ANDRADE and, MARIO e JOSE ROMANACH Orofacial foreign body reactions are adverse effects to cosmetic fillers that are often used for esthetic purpose. Case 1 involved a 76-year-old woman with a painless swelling in the upper lip lasting 1 year. Case 2 involved a 53-year-old woman presenting multiple painless normal-colored nodules of unknown duration located in the lower lip mucosa. Case 3 involved a 77year-old woman with a painless nodule in the right buccal mucosa of unknown duration. All patients admitted having undergone a cosmetic procedure in the past. Microscopically, all cases showed variable-sized empty microcysts, surrounded by a mixture of histiocytes, collagen bundles, multinucleated giant cells, and inflammatory cells. Patients are under follow-up after treatment that consisted of surgical excision of the material. Foreign body reactions to cosmetic fillers are uncommon in the orofacial region.
MULTIPLE HEMANGIOMAS WITH FORMATION OF PHLEBOLITH: CASE REPORT. GILBERTO MARCUCCI, VINICIUS PIOLI e ZANETIM, LEONARDO BRAUN GALVAO MAXIMO DIAS and, MARCELO MARCUCCI Lesions of vascular nature often suffer dystrophic calcification inside, called phleboliths, and are represented by radiopaque areas sometimes forming concentric circles. A white 30-year-old male patient complained of "purple growths in mouth and face for several years." Medical records were not contributory. During physical examination, we found purplish growths with discoloration in the labial mucosa and cutaneous region. During intraoral examination, we observed lesions on the lip mucosa, purplish in the commissures, and purplish nodules on the floor of the mouth and lingual side. Purplish stains are observed in retromolar trigone and lingual dorsum regions. With a diagnosis of hemangiomas, occlusal x-ray was performed, which revealed radiopacities (phleboliths) in the mouth floor corresponding to the vascular lesions of the region. We referred him for a systemic evaluation by a vascular surgeon. Phleboliths can be easily confused with sialoliths, therefore requiring careful consideration by the clinician.