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ORAL VERRUCOUS PEMPHIGUS VEGETANS. A CASE REPORT
OOOO Volume 129, Number 1 K€uttner tumor chronic sclerosing sialadenitis is graded in 4 stages, but most of the lesions are usually diagnosed in the 2 intermediary stages. We present a case affecting a female patient, 57 years old and white, who sought the oral medicine service because of a small tendered nodule on the buccal mucosa. Intraoral examination revealed a sessile, painless, and normal-colored fluctuating nodule, resembling a mucocele. After excisional biopsy, the material was submitted to a microscopic evaluation that revealed dilated salivary ducts with ectasia and peripheral fibrosis with intense hyalinization in addition to a discrete periductal lymphocytic infiltrate in the middle of a stroma of adipose tissue of usual appearance. That suggested diagnosis of advanced stage chronic sclerosing sialadenitis (K€ uttner tumor). Further clinical and laboratory examinations ruled out the other immunomediated diseases. Postoperative follow-up showed no signs of recurrence, and the patient was released.
CONSERVATIVE TREATMENT OF SIMPLE BONE CYST IN THE MANDIBLE. TASSIA CAROLINE DA COSTA MENDES, GUILARDO COSTA DE SOUZA, BRENA CAROLINA DE LIMA ^ PINHEIRO, ANTONIO JORGE DE ARAUJO VASCONC, ELOSII, LIONEY NOBRE CABRAL and, TIAGO NOVAES PINHEIRO Conservative treatment with intralesional steroid injection in bone cysts is considered a simple, low-cost technique that preserves vital structures, avoiding great defects to the patient. A 49year-old black woman sought dental care with pain and numbness in the lower left side of the face. Extraoral examination showed tumefaction in the area corresponding to the lower molars. Computed tomography was performed, revealing a circumscribed intraosseous radiolucency in the region of teeth 36. Puncture with cytologic smear had a suggestive diagnosis of simple bone cyst. Minimal surgical access with little amount of soft and hard tissue was submitted to histopathologic examination. During the procedure, intralesional steroid injection was performed as a therapeutic approach. Histopathologic analysis confirmed the diagnosis. Periodical follow-up during 6 months found bone formation into the cystic cavity site, proving the efficacy of the treatment.
MUCOEPIDERMOID CARCINOMA IN THE BUCCAL MUCOSA: A CASE REPORT WITH EMPHASIS ON CLINICAL AND HISTOPATHOLOGIC FEATURES. ANA CAROLINA MACEDO DA SILVA DIAS, HELLEN BANDEIRA DE PONTES SANTOS, EVERTON DE FREITAS MORAIS, HUGO JOSE CORREIA LOPES, MARCIA CRISTINA DA COSTA MIGUEL, LELIA BATISTA DE SOUZA and, ROSEANA DE ALMEIDA FREITAS Mucoepidermoid carcinoma is one of the most common malignant neoplasms of salivary gland tissue. A 25-year-old patient presented with a painless swelling on the buccal mucosa. The lesion was a 2-cm firm nodule with purple color. The clinical hypothesis was pleomorphic adenoma, and the material was sent for microscopic analysis, which revealed a malignant salivary gland neoplasia characterized by the proliferation of mucous and epidermoid cells organized in solid nests and cystic structures containing amorphous material. The final diagnosis was mucoepidermoid carcinoma. The patient was sent to a referral oncology service for treatment and is under follow-up.
ABSTRACTS
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BURNING MOUTH SYNDROME: LASER THERAPY AS A BIOMODULATOR TREATMENT. BRUNNA RODRIGUES GRISI, SANDRA APARECIDA MARINHO, JOABE DOS SANTOS PEREIRA, GUSTAVO GOMES AGRIPINO, ERNANI ^ DO JUNIOR, CANUTO FIGUEIRE GUSTAVO PINA GODOY and, SERGIO HENRIQUE GONCALVES ¸ DE CARVALHO Burning mouth syndrome (BMS) is an idiopathic and chronic condition affecting women in the postmenopausal period. Case: A 64-year-old female patient came to the stomatology clinic complaining of xerostomia and burning lips. She has controlled hypertension using an antihypertensive, and she has had osteoporosis for 2 years. At the physical examination, there was no noticeable change. Therefore, the patient was diagnosed with BMS. Low-intensity laser therapy was the chosen treatment in addition to orientation for constant hydration. Four sessions were performed weekly using the protocol: Low-intensity laser, 808 nm wavelength, 90 mW of power, 55 J of dosimetry, continuous mode, and punctual application: 15 points in the lower lip, 15 points in the upper lip, and 6 points in large salivary glands. The patient reported total absence of symptomatology after the third session, and she is under follow-up by the stomatology service.
HIGH-POWER DIODE LASER AS A CONSERVATIVE APPROACH FOR ACTINIC CHEILITIS WITH SEVERE DYSPLASIA: CASE REPORT. MILENA THAYS MATIAS DOS SANTOS, LUCAS EMMANUELL DE MORAIS NEVES, DMITRY JOSE DE SANTANA SARMENTO, SANDRA APARECIDA MARINHO, GUSTAVO GOMES AGRIPINO, GUSTAVO PINA GODOY and, SERGIO HENRIQUE GONCALVES ¸ DE CARVALHO A 41-year-old male patient, a white farmer, was referred to the stomatology clinic diagnosed as having actinic cheilitis. Clinically, atrophic and leukoplastic areas were observed throughout the lower lip, and loss of the border between the red lip skin and the cutaneous portion. An incisional biopsy was performed in the leukoplastic area, and histopathologic examination showed atrophic and atypical stratified orthokeratinized pavement epithelium with severe oral epithelial dysplasia. The therapeutic approach was the removal of all leukoplastic areas using the high-intensity diode laser for re-epithelialization of the affected mucosa. Proper follow-up is being performed every 3 months, and after 9 months, no signs of relapse were observed. Because of the potential for malignancy of actinic cheilitis and the presence of dysplastic epithelial alterations, an early approach is justified. The vaporization of the labial tissues with high-intensity diode laser was effective in superficial removal of affected tissues.
ORAL VERRUCOUS PEMPHIGUS VEGETANS. A CASE REPORT. IRENE LAFUENTE e IBANEZ DE MENDOZA, CARMEN PARRA PEREZ, JAVIER ALBERDI NAVARRO, SANTIAGO FERNANDEZ DE PIEROLA and, JOSE MANUEL AGUIRRE URIZAR Pemphigus vegetans is a chronic mucocutaneous autoimmune blistering disease that can involve oral mucosa, whose
ABSTRACTS
e62
behavior is normally benign. We present a case of a 50-year-old man with an unremarkable past medical history who smokes 20 cigarettes every day. For the last 3 months, he has complained of pain on the gums. Clinical examination showed multiple white plaques on the buccal gingiva of all 4 quadrants, with a verrucous appearance, some of which had a reddish area. Incisional biopsies were performed of the lesions from the gingiva with clinical diagnosis of proliferative multifocal leukoplakia as well as a microbiologic culture intake. Histopathologic analysis, showing a verrucous epithelial hyperplasia with acantholysis, confirmed the diagnosis of verrucous pemphigus vegetans. Indirect immunofluorescence results for desmoglein 1 and 3 were negative. The patient remains under control after treatment with deflazacort and triamcinolone. This research was supported by a research group from UPV/EHU.
TUMOR-INFILTRATING IMMUNE CELLS IN NASOPHARYNGEAL ANGIOFIBROMA: SURGICAL MANAGEMENT AND IMMUNOHISTOCHEMICAL ANALYSIS. CARLA BENTO NELEM COLTURATO, ELDON GUTTENBERG CARIRI-NETO, RODRIGO NEVES SILVA, LUCAS RIBEIRO TEIXEIRA, SILVIA ELENA YACARINI PAREDES, XIOMARA BEATRIZ JIMENEZ POLANCO and, JORGE ESQUICHE LEON Nasopharyngeal angiofibroma is a benign but locally aggressive tumor of unknown etiology, typically occurring in the nasopharynx of male adolescents. A 21-year-old male patient was referred presenting left facial swelling and a nodular lesion arising from the upper vestibule. The imaginologic analysis showed a large mass occupying the left maxillary sinus. After incisional biopsy, microscopy exhibited a prominent vascular component constituted by vessels of variable size and shape, supported by cellular stroma, as well as collagenized and fibromyxoid areas. Immunohistochemistry showed positivity for vimentin, a smooth muscle actin, and CD34 and focally for D2-40, desmin, and CD10. Moreover, CD68, CD163, FXIIIA, and CD209 highlighted numerous tumor-infiltrating immune cells, either macrophages or dendritic cells. The Ki-67 was 3%. The Weber Ferguson approach was used to remove the whole lesion. Besides growth factors and androgen receptors, the role of tumor-infiltrating immune cells in nasopharyngeal angiofibroma tumorigenesis should be clarified.
LESION IN THE ANTERIOR MANDIBLE: CASE REPORT OF A GLANDULAR ODONTOGENIC CYST IN AN ELDERLY PATIENT. ARTHUR PIAS SALGUEIRO, JULIANA ROMANINI, ISADORA FOLLAK DE SOUZA, LAURA CAMPOS HILDEBRAND, FERNANDA VISIOLI, MARCIA GAIGER DE OILIVEIRA and, PANTELIS VARVAKI RADOS A 70-year-old white male patient sought care to evaluate an asymptomatic lesion identified on radiographic study for clinical reasons. A radiographic radiolucent defect was located between the lower central incisors roots. A defect in the oral mucosa was observed close to the left side of lingual frenulum, resembling a fistula. An excisional biopsy was performed, and the material sent to microscopic study revealed a cystic cavity lined by nonkeratinized squamous epithelial tissue with bundles along the epithelial lining. The presence of goblet cells was also observed, and the epithelial-mesenchymal junction showed a flat union.
OOOO January 2020 There is hyaline material inside the cystic cavity. The lesion was surrounded by fibrous connective tissue. The final diagnosis was suggestive of a glandular odontogenic cyst. The patient is under follow-up without symptoms or signs of radiographic recurrence in the period of 12 months.
GINGIVAL SQUAMOUS CELL CARCINOMA: ERIKA A CASE REPORT. RAISA SALES DE SA, GRAFF PEDROSO, LEONARDO AMARAL DOS REIS, DIEGO TETZNER FERNANDES, ALAN ROGER SANTOS-SILVA, OSLEI PAES DE ALMEIDA and, MARCIO AJUDARTE LOPES Squamous cell carcinoma rarely occurs in the gingiva and may be misdiagnosed as inflammatory lesions that most commonly affect this area. A 51-year-old patient was referred for evaluation of a lesion in the gingiva. The patient was nonsmoker and nondrinker, and he reported local symptomatology for 3 years since the lower left first molar was rehabilitated with porcelain crown. On oral examination an erythematous lesion in the vestibular marginal gingiva of the lower left first molar was observed. In addition, white areas in the lower anterior vestibular gingiva were present. In view of the clinical hypothesis of malignant neoplasia, incisional biopsy was performed, and the histopathologic analysis confirmed the diagnosis of squamous cell carcinoma. The patient was referred to a head and neck surgeon, who performed a surgical removal of the tumor. This report emphasizes that although is uncommon, squamous cell carcinoma of gingiva may occur and may mimic an inflammatory process.
ORAL AND MAXILLOFACIAL OSTEOSARCOMA: CASE REPORT. CRISTIANNE KALINNE SANTOS MEDEIROS, RANI IANI COSTA GONCALO, ¸ HUMBERTO PEREIRA CHAVES NETO, GERMANO DE LELIS BEZERRA JUNIOR, ADRIANO ROCHA GERMANO and, LELIA MARIA GUEDES QUEIROZ A 43-year-old female patient attended the oral maxillofacial and traumatology service presenting volume increase in the right hemiface with painful symptomatology. At the intraoral examination, an exophytic lesion involving the alveolar ridge and palate region was observed, extending to the right nostril. The lesion showed a partially ulcerated surface, with purulent secretion, firm consistency, and normal mucosal color. Computed tomography revealed a mixed appearance of hyperdensity and ill-defined hypodensity in the maxillary region with extension to the zygoma and the right orbit. Because of poor oral hygiene and a history of regression with antibiotic therapy, a clinical diagnosis of actinomycosis was issued, and incisional biopsy of the lesion was subsequently performed. In the microscopic analysis, proliferation of pleomorphic and atypical malignant mesenchymal cells was associated with deposition of osteoid matrix, thus confirming the histopathologic diagnosis of osteosarcoma. The patient was referred to the State Reference Center for appropriate treatment.
IMPORTANCE OF FOLLOW-UP FOR LIP SQUAMOUS CELL CARCINOMA: REPORT OF 2 CASES. PAULA SANTOS FERREIRA, DARCY FERNANDES, ANDREIA BUFALINO, TULIO MORANDIN FERRISSE, AUDREY FOSTER LEFORT
CONSERVATIVE TREATMENT OF SIMPLE BONE CYST IN THE MANDIBLE. TASSIA CAROLINE DA COSTA MENDES, GUILARDO COSTA DE SOUZA, BRENA CAROLINA DE LIMA ^ PINHEIRO, ANTONIO JORGE DE ARAUJO VASCONC, ELOSII, LIONEY NOBRE CABRAL and, TIAGO NOVAES PINHEIRO Conservative treatment with intralesional steroid injection in bone cysts is considered a simple, low-cost technique that preserves vital structures, avoiding great defects to the patient. A 49year-old black woman sought dental care with pain and numbness in the lower left side of the face. Extraoral examination showed tumefaction in the area corresponding to the lower molars. Computed tomography was performed, revealing a circumscribed intraosseous radiolucency in the region of teeth 36. Puncture with cytologic smear had a suggestive diagnosis of simple bone cyst. Minimal surgical access with little amount of soft and hard tissue was submitted to histopathologic examination. During the procedure, intralesional steroid injection was performed as a therapeutic approach. Histopathologic analysis confirmed the diagnosis. Periodical follow-up during 6 months found bone formation into the cystic cavity site, proving the efficacy of the treatment.
MUCOEPIDERMOID CARCINOMA IN THE BUCCAL MUCOSA: A CASE REPORT WITH EMPHASIS ON CLINICAL AND HISTOPATHOLOGIC FEATURES. ANA CAROLINA MACEDO DA SILVA DIAS, HELLEN BANDEIRA DE PONTES SANTOS, EVERTON DE FREITAS MORAIS, HUGO JOSE CORREIA LOPES, MARCIA CRISTINA DA COSTA MIGUEL, LELIA BATISTA DE SOUZA and, ROSEANA DE ALMEIDA FREITAS Mucoepidermoid carcinoma is one of the most common malignant neoplasms of salivary gland tissue. A 25-year-old patient presented with a painless swelling on the buccal mucosa. The lesion was a 2-cm firm nodule with purple color. The clinical hypothesis was pleomorphic adenoma, and the material was sent for microscopic analysis, which revealed a malignant salivary gland neoplasia characterized by the proliferation of mucous and epidermoid cells organized in solid nests and cystic structures containing amorphous material. The final diagnosis was mucoepidermoid carcinoma. The patient was sent to a referral oncology service for treatment and is under follow-up.
ABSTRACTS
e61
BURNING MOUTH SYNDROME: LASER THERAPY AS A BIOMODULATOR TREATMENT. BRUNNA RODRIGUES GRISI, SANDRA APARECIDA MARINHO, JOABE DOS SANTOS PEREIRA, GUSTAVO GOMES AGRIPINO, ERNANI ^ DO JUNIOR, CANUTO FIGUEIRE GUSTAVO PINA GODOY and, SERGIO HENRIQUE GONCALVES ¸ DE CARVALHO Burning mouth syndrome (BMS) is an idiopathic and chronic condition affecting women in the postmenopausal period. Case: A 64-year-old female patient came to the stomatology clinic complaining of xerostomia and burning lips. She has controlled hypertension using an antihypertensive, and she has had osteoporosis for 2 years. At the physical examination, there was no noticeable change. Therefore, the patient was diagnosed with BMS. Low-intensity laser therapy was the chosen treatment in addition to orientation for constant hydration. Four sessions were performed weekly using the protocol: Low-intensity laser, 808 nm wavelength, 90 mW of power, 55 J of dosimetry, continuous mode, and punctual application: 15 points in the lower lip, 15 points in the upper lip, and 6 points in large salivary glands. The patient reported total absence of symptomatology after the third session, and she is under follow-up by the stomatology service.
HIGH-POWER DIODE LASER AS A CONSERVATIVE APPROACH FOR ACTINIC CHEILITIS WITH SEVERE DYSPLASIA: CASE REPORT. MILENA THAYS MATIAS DOS SANTOS, LUCAS EMMANUELL DE MORAIS NEVES, DMITRY JOSE DE SANTANA SARMENTO, SANDRA APARECIDA MARINHO, GUSTAVO GOMES AGRIPINO, GUSTAVO PINA GODOY and, SERGIO HENRIQUE GONCALVES ¸ DE CARVALHO A 41-year-old male patient, a white farmer, was referred to the stomatology clinic diagnosed as having actinic cheilitis. Clinically, atrophic and leukoplastic areas were observed throughout the lower lip, and loss of the border between the red lip skin and the cutaneous portion. An incisional biopsy was performed in the leukoplastic area, and histopathologic examination showed atrophic and atypical stratified orthokeratinized pavement epithelium with severe oral epithelial dysplasia. The therapeutic approach was the removal of all leukoplastic areas using the high-intensity diode laser for re-epithelialization of the affected mucosa. Proper follow-up is being performed every 3 months, and after 9 months, no signs of relapse were observed. Because of the potential for malignancy of actinic cheilitis and the presence of dysplastic epithelial alterations, an early approach is justified. The vaporization of the labial tissues with high-intensity diode laser was effective in superficial removal of affected tissues.
ORAL VERRUCOUS PEMPHIGUS VEGETANS. A CASE REPORT. IRENE LAFUENTE e IBANEZ DE MENDOZA, CARMEN PARRA PEREZ, JAVIER ALBERDI NAVARRO, SANTIAGO FERNANDEZ DE PIEROLA and, JOSE MANUEL AGUIRRE URIZAR Pemphigus vegetans is a chronic mucocutaneous autoimmune blistering disease that can involve oral mucosa, whose
ABSTRACTS
e62
behavior is normally benign. We present a case of a 50-year-old man with an unremarkable past medical history who smokes 20 cigarettes every day. For the last 3 months, he has complained of pain on the gums. Clinical examination showed multiple white plaques on the buccal gingiva of all 4 quadrants, with a verrucous appearance, some of which had a reddish area. Incisional biopsies were performed of the lesions from the gingiva with clinical diagnosis of proliferative multifocal leukoplakia as well as a microbiologic culture intake. Histopathologic analysis, showing a verrucous epithelial hyperplasia with acantholysis, confirmed the diagnosis of verrucous pemphigus vegetans. Indirect immunofluorescence results for desmoglein 1 and 3 were negative. The patient remains under control after treatment with deflazacort and triamcinolone. This research was supported by a research group from UPV/EHU.
TUMOR-INFILTRATING IMMUNE CELLS IN NASOPHARYNGEAL ANGIOFIBROMA: SURGICAL MANAGEMENT AND IMMUNOHISTOCHEMICAL ANALYSIS. CARLA BENTO NELEM COLTURATO, ELDON GUTTENBERG CARIRI-NETO, RODRIGO NEVES SILVA, LUCAS RIBEIRO TEIXEIRA, SILVIA ELENA YACARINI PAREDES, XIOMARA BEATRIZ JIMENEZ POLANCO and, JORGE ESQUICHE LEON Nasopharyngeal angiofibroma is a benign but locally aggressive tumor of unknown etiology, typically occurring in the nasopharynx of male adolescents. A 21-year-old male patient was referred presenting left facial swelling and a nodular lesion arising from the upper vestibule. The imaginologic analysis showed a large mass occupying the left maxillary sinus. After incisional biopsy, microscopy exhibited a prominent vascular component constituted by vessels of variable size and shape, supported by cellular stroma, as well as collagenized and fibromyxoid areas. Immunohistochemistry showed positivity for vimentin, a smooth muscle actin, and CD34 and focally for D2-40, desmin, and CD10. Moreover, CD68, CD163, FXIIIA, and CD209 highlighted numerous tumor-infiltrating immune cells, either macrophages or dendritic cells. The Ki-67 was 3%. The Weber Ferguson approach was used to remove the whole lesion. Besides growth factors and androgen receptors, the role of tumor-infiltrating immune cells in nasopharyngeal angiofibroma tumorigenesis should be clarified.
LESION IN THE ANTERIOR MANDIBLE: CASE REPORT OF A GLANDULAR ODONTOGENIC CYST IN AN ELDERLY PATIENT. ARTHUR PIAS SALGUEIRO, JULIANA ROMANINI, ISADORA FOLLAK DE SOUZA, LAURA CAMPOS HILDEBRAND, FERNANDA VISIOLI, MARCIA GAIGER DE OILIVEIRA and, PANTELIS VARVAKI RADOS A 70-year-old white male patient sought care to evaluate an asymptomatic lesion identified on radiographic study for clinical reasons. A radiographic radiolucent defect was located between the lower central incisors roots. A defect in the oral mucosa was observed close to the left side of lingual frenulum, resembling a fistula. An excisional biopsy was performed, and the material sent to microscopic study revealed a cystic cavity lined by nonkeratinized squamous epithelial tissue with bundles along the epithelial lining. The presence of goblet cells was also observed, and the epithelial-mesenchymal junction showed a flat union.
OOOO January 2020 There is hyaline material inside the cystic cavity. The lesion was surrounded by fibrous connective tissue. The final diagnosis was suggestive of a glandular odontogenic cyst. The patient is under follow-up without symptoms or signs of radiographic recurrence in the period of 12 months.
GINGIVAL SQUAMOUS CELL CARCINOMA: ERIKA A CASE REPORT. RAISA SALES DE SA, GRAFF PEDROSO, LEONARDO AMARAL DOS REIS, DIEGO TETZNER FERNANDES, ALAN ROGER SANTOS-SILVA, OSLEI PAES DE ALMEIDA and, MARCIO AJUDARTE LOPES Squamous cell carcinoma rarely occurs in the gingiva and may be misdiagnosed as inflammatory lesions that most commonly affect this area. A 51-year-old patient was referred for evaluation of a lesion in the gingiva. The patient was nonsmoker and nondrinker, and he reported local symptomatology for 3 years since the lower left first molar was rehabilitated with porcelain crown. On oral examination an erythematous lesion in the vestibular marginal gingiva of the lower left first molar was observed. In addition, white areas in the lower anterior vestibular gingiva were present. In view of the clinical hypothesis of malignant neoplasia, incisional biopsy was performed, and the histopathologic analysis confirmed the diagnosis of squamous cell carcinoma. The patient was referred to a head and neck surgeon, who performed a surgical removal of the tumor. This report emphasizes that although is uncommon, squamous cell carcinoma of gingiva may occur and may mimic an inflammatory process.
ORAL AND MAXILLOFACIAL OSTEOSARCOMA: CASE REPORT. CRISTIANNE KALINNE SANTOS MEDEIROS, RANI IANI COSTA GONCALO, ¸ HUMBERTO PEREIRA CHAVES NETO, GERMANO DE LELIS BEZERRA JUNIOR, ADRIANO ROCHA GERMANO and, LELIA MARIA GUEDES QUEIROZ A 43-year-old female patient attended the oral maxillofacial and traumatology service presenting volume increase in the right hemiface with painful symptomatology. At the intraoral examination, an exophytic lesion involving the alveolar ridge and palate region was observed, extending to the right nostril. The lesion showed a partially ulcerated surface, with purulent secretion, firm consistency, and normal mucosal color. Computed tomography revealed a mixed appearance of hyperdensity and ill-defined hypodensity in the maxillary region with extension to the zygoma and the right orbit. Because of poor oral hygiene and a history of regression with antibiotic therapy, a clinical diagnosis of actinomycosis was issued, and incisional biopsy of the lesion was subsequently performed. In the microscopic analysis, proliferation of pleomorphic and atypical malignant mesenchymal cells was associated with deposition of osteoid matrix, thus confirming the histopathologic diagnosis of osteosarcoma. The patient was referred to the State Reference Center for appropriate treatment.
IMPORTANCE OF FOLLOW-UP FOR LIP SQUAMOUS CELL CARCINOMA: REPORT OF 2 CASES. PAULA SANTOS FERREIRA, DARCY FERNANDES, ANDREIA BUFALINO, TULIO MORANDIN FERRISSE, AUDREY FOSTER LEFORT