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PLEOMORPHIC ADENOMA OCCUPYING THE INFRATEMPORAL SPACE: A CASE REPORT
OOOO Volume 129, Number 1 cells, which have abundant cytoplasm filled with eosinophilic granules that resemble lysosomes. A 37-year-old male patient was referred to a maxillofacial surgery clinic with swelling in the mandible noticed 10 years earlier. Two previous biopsy results were suggestive of ameloblastoma. Intraorally, there was a nodular swelling in the right alveolar ridge involving the region of premolars and molars, and computed tomography showed an expansible and multilocular lytic lesion. Histologic examination revealed a lesion composed of fibrous stroma with cell sheets presenting extensive granular cell transformation, surrounded by peripheral ameloblast-like cells. Immunohistochemistry showed negativity for Ki-67. The diagnosis was GCA. A marginal resection of the mandible was performed, and the microscopic examination confirmed the diagnosis. The patient remains in monitoring, and the reconstruction surgery of the mandible will be held soon.
ORAL MANIFESTATION OF CROHN DISEASE - A CASE REPORT. RUCHIELLI LOUREIRO BORGHETTI, LETICIA SPINELLI JACOBY, MARIA EDUARDA LANES BALDINO, JULIANE DE QUADROS DE BORTOLLI, KAREN CHERUBINI, MARIA ANTONIA ZANCANARO DE FIGUEIREDO and, FERNANDA GONCALVES ¸ SALUM A 29-year-old male patient was referred to a specialized service with gingival lesions that lasted 10 years. The medical history showed untreated Crohn disease. Intraoral examination detected firm nodules at the vestibular retromolar region of the right and left mandibular molar, red in color, recovered by ulcerated mucosa, and both measuring 2 cm. The buccal mucosa revealed a swollen, cobllestone appearance and showed deep linear ulcerations. Incisional biopsy was performed, and histopathologic analysis showed a connective tissue with intense chronic inflammatory infiltrate and neutrophils, blood vessel neoformation, and epithelioid cells. We recommended the use of 0.12% topical chlorhexidine. Because of persistent oral lesions, the patient was redirected to a gastroenterologist for further investigations and systemic treatment. Clinical control remains for 2 months. Approximately one-third of Crohn disease patients develop extraintestinal manifestations. Treatment of oral lesions included treatment of the intestinal disease and cooperation between gastroenterologists and specialists in oral medicine.
ERYTHEMA MULTIFORME. KAREN MARIA e GUIMARAES PACHECO, ALINE PEREIRA BERNARDINO, THIAGO CORDEIRO PIMENTEL MAFRA, CAROLINA PONTELO PIRES, e ARMOND and, FABIOLA DAVI DE NUNES, SEBASTIAO HERMINIA MARQUES CAPISTRANO A 58-year-old woman attended a clinic with “lumps in the hands and wounds on the mouth that appeared a year ago, that would come and go.” On the last recurrence, “blisters were formed.” She reported using antibiotics, antidepressants, antihypertensives, and analgesics. On extraoral examination, dark macules on the arms and hands were observed. On intraoral examination, ulcerated lesions and white plaques on the buccal mucosa were observed bilaterally. An incisional biopsy was performed, and the diagnosis was nonspecific inflammatory process. Then, a 1mL intramuscular injection of betamethasone dipropionate was prescribed. After 15 days lesions on the buccal mucosa recurred. The patient returned with new skin lesion erythematous in the
ABSTRACTS
e81
form of a target, which proved the diagnosis of erythema multiforme, and 1-mL intramuscular injections of betamethasone dipropionate were applied. The doctor discontinued the analgesics and antibiotics. After 6 months, the patient returned with no lesions but with scars.
AMELOBLASTIC FIBRODENTINOMA: CASE e DE ANDRADE, REPORT. IAN MAGALHAES EDUARDA GALLITO FERES, MIRIAM e BEATRIZ JORDAO MOREIRA SARRUF, RODRIGO FIGUEIREDO DE BRITO RESENDE, ADRIANA TEREZINHA NEVES NOVELLINO ALVES, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ and, JOSIANE COSTA RODRIGUES DE SA A 10-year-old white male patient was referred to the clinic because of absence of tooth 37. Extraoral examination was irrelevant. Intraoral examination showed absence of tooth 37 and the left inferior retromolar region covered by normal mucosa with normal bone contour. Cone beam computed tomography revealed unilocular hypodense image with hyperdense margin and hyperdense foci inside, between the unerupted teeth 36 and 37, which was displaced. Diagnostic hypothesis was odontoma. Treatment consisted of lesion excision under local anesthesia, and tooth 37 has been maintained. The histopathologic report confirmed the final diagnosis of ameloblastic fibrodentinoma. The patient is under follow-up without relapse.
RECONSTRUCTION OF THE MIDDLE THIRD OF THE FACE WITH PARALLEL SEGMENTS WITH MICROVASCULAR FIBULAR FLAP: NEW TECHNIQUE. LAURINDO MOACIR SASSI, JOSE L DISSENHA, MARIA ISABELA GUEBUR, FERNANDO L ZANFERRARI, ALFREDO B SILVA, PAOLA A.G. PEDRUZZI and, GYL H.A. RAMOS Each reconstruction has its differences. Our objective was to show a different way. Study Design: A.R.F., an 18-year-old white man, presented a tumor with diagnosis of fibrous dysplasia in the maxillary bone (M), palate, and zygomatic complex (ZC) on the left side. After the maxillectomy with immediate reconstruction, we observed the anatomic flaw of the M caused by the tumor removal. When in power of the vascularized fibula, it was possible to cut, with osteotomy, in 4 segments, with each segment length depending on the size of the bone flaw. The first segment was used to reconstruct the orbit floor and ZC. The second one (3 cm) was discarded. The third one was used to reconstruct the M on the medium line to the third superior molar. Finally, the fourth segment formed an angle of 90 degrees with the third segment from the distal portion. Conclusion: This surgical technique presented a satisfactory result.
PLEOMORPHIC ADENOMA OCCUPYING THE INFRATEMPORAL SPACE: A CASE REPORT. JESSICA AMORIM THEOTONIO, ADRIANA TEREZINHA NEVES NOVELLINO ALVES, ANA e LEITE, SIMONE DE FLAVIA SCHUELER DE ASSUMP¸C AO QUEIROZ CHAVES LOURENCO, ¸ GLAUCO SIQUEIRA LIMA, RODRIGO EL-HAYCK FERREIRA and, ALEXANDRE MOREIRA DE MORAES
ABSTRACTS
e82
Pleomorphic adenoma is the most common benign neoplasm of salivary glands, representing about 33% to 43% of tumors of the minor salivary gland. The palate is the most frequent intraoral site followed by the upper lip and the buccal mucosa. This report describes the development of pleomorphic adenoma in the infratemporal space in a 72-year-old woman. The lesion presented as a submucosal nodule, palpable deep in the left buccal mucosa. The computed tomography revealed a lobed hypodense formation partially obliterating the fat planes between the masseter and buccinator muscles. Surgical excision of the lesion was performed with histopathologic report of pleomorphic adenoma, and the patient is being followed up for 5 months with no signs of recurrence. It is important to note the unusual location and the importance of investigation and diagnostic elucidation for the correct therapeutic approach.
ADENOID CYSTIC CARCINOMA OF MINOR SALIVARY GLANDS: CASE REPORT. CAMILA OLIVEIRA SANTOS, ALYNE AMORIM DE ARAUJO, RODRIGO RESENDE, VANIA DO CARMO, LUISA AGUIRRE BUEXM, ADRIANA TEREZINHA NEVES NOVELLINO ALVES and, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ Adenoid cystic carcinoma (ACC) is a malignant neoplasm of salivary glands that, with slow growth and infiltrative tumor, clinically is characterized by a firm mass. A 49-year-old brown female patient sought dental care with complaints of “headaches and nasal congestion over 10 months.” On the anamnesis she reported systemic arterial hypertension. Extraoral examination revealed facial asymmetry in the left maxillary region and absence of palpable lymph nodes. The intraoral examination revealed an increase in volume and ulcerated lesions in the left hard palate region. Radiopaque examination of the maxillary sinus and reabsorption of the 28 were performed on the radiographic examination. An incisional biopsy was performed with a diagnostic hypothesis of lymphoma. Histopathology reported an ACC. The patient was referred for oncologic treatment and will undergo subtotal maxillectomy with reconstruction by head and neck microsurgery. The biological aggressiveness of ACC is usually underestimated because of slow growth.
INTRAMUSCULAR HEMANGIOMA OF THE LOWER LIP. DANIEL CAETANO, FERNANDO LIMA, WLADIMIR CORTEZZI, BEATRIZ CORDEIRO, MICHELLE AGOSTINI, BRUNO AUGUSTO BENEVENUTO and, MARIO JOSE e ROMANACH Intramuscular hemangioma (IH) is relatively uncommon, accounting for less than 1% of all hemangiomas, usually located within the skeletal muscles of the trunk or limbs, particularly in the pelvic region. Approximately 10% of IH may occur in the head and neck region, most commonly affecting the masseter, sternocleidomastoid, and trapezius muscles. A 57-year-old man was referred for evaluation of a 4-cm asymptomatic, bluish, and slow-growing swelling of the lower lip. The patient’s history included lower lip trauma and bleeding 5 years earlier. The clinical differential diagnosis included mucocele, angioleiomyoma, and salivary gland tumor. The patient was submitted to excisional biopsy under general anesthesia. Microscopically, proliferating vascular channels lined by endothelium and smooth muscle were observed infiltrating diffusely skeletal muscles, adipose tissue, and connective tissue. The final diagnosis was IH.
OOOO January 2020 The patient is under regular follow-up with no recurrence. IH rarely affects the lips.
GRANULAR CELL TUMOR: CASE REPORT. HERIKA CRISTINA SILVA DE SOUZA, SIMONE HENRIQUES MACHADO, ANA e LEITE, ADRIANA FLAVIA SCHUELER DE ASSUMP¸C AO TEREZINHA NEVES NOVELLINO ALVES, LUCIANA WERNERSBACH PINTO and, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ Patient D.S.O., a 38-year-old black woman who was a smoker for 27 years, sought dental care complaining of “a ball that appeared on the tongue after eating fish and the fishbone stuck into the tongue.” There was a gradual volumetric increase in region corresponding to the dorsum of the tongue for 5 years. On intraoral examination, a soft tissue nodule was found on the dorsum of the tongue, which was exophytic, sessile, single, welldelimited, elliptical, of firm consistency, smooth, white, asymptomatic, and measured about 5 cm. Preoperative laboratory testing was requested: complete blood count, coagulogram, and glucose, all with normal values. An excisional biopsy was performed for histopathologic examination. The clinical diagnosis was irritation fibroma. The histopathologic diagnosis was granular cell tumor. In the postoperative period there were no signs and symptoms. The granular cell tumor is rare tumor with the uncertain histogenesis and shows greater predilection for the oral cavity.
VASCULAR LEIOMYOMA: A RARE CASE REPORT IN THE BUCCAL MUCOSA. JAQUELINE LEMES RIBEIRO, FERNANDA HERRERA DA COSTA, RENATA MENDONCA ¸ MORAES, ANA SUELI RODRIGUES CAVALCANTE, ESTELA KAMINAGAKURA TANGO, YASMIN RODARTE CARVALHO and, ANA LIA ANBINDER Angioleiomyoma is a benign neoplasm with perivascular smooth muscle origin and is rare in the mouth. A male patient presented to our service with the chief complaint of an asymptomatic facial lesion. In the intraoral examination, a 1.5-cm submucosal nodule in the left cheek was observed. Doppler ultrasonography showed an image of a lobulated, hyperechoic nodule with defined limits and no change in the blood flow. The clinical hypotheses were lipoma, solitary fibrous tumor, and salivary gland neoplasm. Histologic examination after excisional biopsy revealed a delimited lesion, presenting multiple vascular spaces of varying sizes and calibers, sometimes congested and interconnected, covered by endothelium and spindle cell layers of variable thickness. A mixed thrombus with an organization area composed of granulation tissue was also found. Neoplastic cells were immunoreactive for smooth muscle actin and negative for CD34, confirming the diagnosis of angioleiomyoma. After 6 months of follow-up, no signs of recurrence were observed.
GIANT CELL TUMOR IN SINUS MAXILLARY AND NASAL CAVITY: A RARE CASE REPORT. BRENDO VINICIUS RODRIGUES LOUREDO, GERSON DE OLIVEIRA PAIVA NETO, ELIANDRO DE SOUZA FREITAS, FRANCISCO AMADIS BATISTA TATIANA NAYARA FERREIRA, FABIO ARRUDA BINDA, ^ LIBORIO-KIMURA and, JECONIAS CAMARA
ORAL MANIFESTATION OF CROHN DISEASE - A CASE REPORT. RUCHIELLI LOUREIRO BORGHETTI, LETICIA SPINELLI JACOBY, MARIA EDUARDA LANES BALDINO, JULIANE DE QUADROS DE BORTOLLI, KAREN CHERUBINI, MARIA ANTONIA ZANCANARO DE FIGUEIREDO and, FERNANDA GONCALVES ¸ SALUM A 29-year-old male patient was referred to a specialized service with gingival lesions that lasted 10 years. The medical history showed untreated Crohn disease. Intraoral examination detected firm nodules at the vestibular retromolar region of the right and left mandibular molar, red in color, recovered by ulcerated mucosa, and both measuring 2 cm. The buccal mucosa revealed a swollen, cobllestone appearance and showed deep linear ulcerations. Incisional biopsy was performed, and histopathologic analysis showed a connective tissue with intense chronic inflammatory infiltrate and neutrophils, blood vessel neoformation, and epithelioid cells. We recommended the use of 0.12% topical chlorhexidine. Because of persistent oral lesions, the patient was redirected to a gastroenterologist for further investigations and systemic treatment. Clinical control remains for 2 months. Approximately one-third of Crohn disease patients develop extraintestinal manifestations. Treatment of oral lesions included treatment of the intestinal disease and cooperation between gastroenterologists and specialists in oral medicine.
ERYTHEMA MULTIFORME. KAREN MARIA e GUIMARAES PACHECO, ALINE PEREIRA BERNARDINO, THIAGO CORDEIRO PIMENTEL MAFRA, CAROLINA PONTELO PIRES, e ARMOND and, FABIOLA DAVI DE NUNES, SEBASTIAO HERMINIA MARQUES CAPISTRANO A 58-year-old woman attended a clinic with “lumps in the hands and wounds on the mouth that appeared a year ago, that would come and go.” On the last recurrence, “blisters were formed.” She reported using antibiotics, antidepressants, antihypertensives, and analgesics. On extraoral examination, dark macules on the arms and hands were observed. On intraoral examination, ulcerated lesions and white plaques on the buccal mucosa were observed bilaterally. An incisional biopsy was performed, and the diagnosis was nonspecific inflammatory process. Then, a 1mL intramuscular injection of betamethasone dipropionate was prescribed. After 15 days lesions on the buccal mucosa recurred. The patient returned with new skin lesion erythematous in the
ABSTRACTS
e81
form of a target, which proved the diagnosis of erythema multiforme, and 1-mL intramuscular injections of betamethasone dipropionate were applied. The doctor discontinued the analgesics and antibiotics. After 6 months, the patient returned with no lesions but with scars.
AMELOBLASTIC FIBRODENTINOMA: CASE e DE ANDRADE, REPORT. IAN MAGALHAES EDUARDA GALLITO FERES, MIRIAM e BEATRIZ JORDAO MOREIRA SARRUF, RODRIGO FIGUEIREDO DE BRITO RESENDE, ADRIANA TEREZINHA NEVES NOVELLINO ALVES, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ and, JOSIANE COSTA RODRIGUES DE SA A 10-year-old white male patient was referred to the clinic because of absence of tooth 37. Extraoral examination was irrelevant. Intraoral examination showed absence of tooth 37 and the left inferior retromolar region covered by normal mucosa with normal bone contour. Cone beam computed tomography revealed unilocular hypodense image with hyperdense margin and hyperdense foci inside, between the unerupted teeth 36 and 37, which was displaced. Diagnostic hypothesis was odontoma. Treatment consisted of lesion excision under local anesthesia, and tooth 37 has been maintained. The histopathologic report confirmed the final diagnosis of ameloblastic fibrodentinoma. The patient is under follow-up without relapse.
RECONSTRUCTION OF THE MIDDLE THIRD OF THE FACE WITH PARALLEL SEGMENTS WITH MICROVASCULAR FIBULAR FLAP: NEW TECHNIQUE. LAURINDO MOACIR SASSI, JOSE L DISSENHA, MARIA ISABELA GUEBUR, FERNANDO L ZANFERRARI, ALFREDO B SILVA, PAOLA A.G. PEDRUZZI and, GYL H.A. RAMOS Each reconstruction has its differences. Our objective was to show a different way. Study Design: A.R.F., an 18-year-old white man, presented a tumor with diagnosis of fibrous dysplasia in the maxillary bone (M), palate, and zygomatic complex (ZC) on the left side. After the maxillectomy with immediate reconstruction, we observed the anatomic flaw of the M caused by the tumor removal. When in power of the vascularized fibula, it was possible to cut, with osteotomy, in 4 segments, with each segment length depending on the size of the bone flaw. The first segment was used to reconstruct the orbit floor and ZC. The second one (3 cm) was discarded. The third one was used to reconstruct the M on the medium line to the third superior molar. Finally, the fourth segment formed an angle of 90 degrees with the third segment from the distal portion. Conclusion: This surgical technique presented a satisfactory result.
PLEOMORPHIC ADENOMA OCCUPYING THE INFRATEMPORAL SPACE: A CASE REPORT. JESSICA AMORIM THEOTONIO, ADRIANA TEREZINHA NEVES NOVELLINO ALVES, ANA e LEITE, SIMONE DE FLAVIA SCHUELER DE ASSUMP¸C AO QUEIROZ CHAVES LOURENCO, ¸ GLAUCO SIQUEIRA LIMA, RODRIGO EL-HAYCK FERREIRA and, ALEXANDRE MOREIRA DE MORAES
ABSTRACTS
e82
Pleomorphic adenoma is the most common benign neoplasm of salivary glands, representing about 33% to 43% of tumors of the minor salivary gland. The palate is the most frequent intraoral site followed by the upper lip and the buccal mucosa. This report describes the development of pleomorphic adenoma in the infratemporal space in a 72-year-old woman. The lesion presented as a submucosal nodule, palpable deep in the left buccal mucosa. The computed tomography revealed a lobed hypodense formation partially obliterating the fat planes between the masseter and buccinator muscles. Surgical excision of the lesion was performed with histopathologic report of pleomorphic adenoma, and the patient is being followed up for 5 months with no signs of recurrence. It is important to note the unusual location and the importance of investigation and diagnostic elucidation for the correct therapeutic approach.
ADENOID CYSTIC CARCINOMA OF MINOR SALIVARY GLANDS: CASE REPORT. CAMILA OLIVEIRA SANTOS, ALYNE AMORIM DE ARAUJO, RODRIGO RESENDE, VANIA DO CARMO, LUISA AGUIRRE BUEXM, ADRIANA TEREZINHA NEVES NOVELLINO ALVES and, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ Adenoid cystic carcinoma (ACC) is a malignant neoplasm of salivary glands that, with slow growth and infiltrative tumor, clinically is characterized by a firm mass. A 49-year-old brown female patient sought dental care with complaints of “headaches and nasal congestion over 10 months.” On the anamnesis she reported systemic arterial hypertension. Extraoral examination revealed facial asymmetry in the left maxillary region and absence of palpable lymph nodes. The intraoral examination revealed an increase in volume and ulcerated lesions in the left hard palate region. Radiopaque examination of the maxillary sinus and reabsorption of the 28 were performed on the radiographic examination. An incisional biopsy was performed with a diagnostic hypothesis of lymphoma. Histopathology reported an ACC. The patient was referred for oncologic treatment and will undergo subtotal maxillectomy with reconstruction by head and neck microsurgery. The biological aggressiveness of ACC is usually underestimated because of slow growth.
INTRAMUSCULAR HEMANGIOMA OF THE LOWER LIP. DANIEL CAETANO, FERNANDO LIMA, WLADIMIR CORTEZZI, BEATRIZ CORDEIRO, MICHELLE AGOSTINI, BRUNO AUGUSTO BENEVENUTO and, MARIO JOSE e ROMANACH Intramuscular hemangioma (IH) is relatively uncommon, accounting for less than 1% of all hemangiomas, usually located within the skeletal muscles of the trunk or limbs, particularly in the pelvic region. Approximately 10% of IH may occur in the head and neck region, most commonly affecting the masseter, sternocleidomastoid, and trapezius muscles. A 57-year-old man was referred for evaluation of a 4-cm asymptomatic, bluish, and slow-growing swelling of the lower lip. The patient’s history included lower lip trauma and bleeding 5 years earlier. The clinical differential diagnosis included mucocele, angioleiomyoma, and salivary gland tumor. The patient was submitted to excisional biopsy under general anesthesia. Microscopically, proliferating vascular channels lined by endothelium and smooth muscle were observed infiltrating diffusely skeletal muscles, adipose tissue, and connective tissue. The final diagnosis was IH.
OOOO January 2020 The patient is under regular follow-up with no recurrence. IH rarely affects the lips.
GRANULAR CELL TUMOR: CASE REPORT. HERIKA CRISTINA SILVA DE SOUZA, SIMONE HENRIQUES MACHADO, ANA e LEITE, ADRIANA FLAVIA SCHUELER DE ASSUMP¸C AO TEREZINHA NEVES NOVELLINO ALVES, LUCIANA WERNERSBACH PINTO and, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ Patient D.S.O., a 38-year-old black woman who was a smoker for 27 years, sought dental care complaining of “a ball that appeared on the tongue after eating fish and the fishbone stuck into the tongue.” There was a gradual volumetric increase in region corresponding to the dorsum of the tongue for 5 years. On intraoral examination, a soft tissue nodule was found on the dorsum of the tongue, which was exophytic, sessile, single, welldelimited, elliptical, of firm consistency, smooth, white, asymptomatic, and measured about 5 cm. Preoperative laboratory testing was requested: complete blood count, coagulogram, and glucose, all with normal values. An excisional biopsy was performed for histopathologic examination. The clinical diagnosis was irritation fibroma. The histopathologic diagnosis was granular cell tumor. In the postoperative period there were no signs and symptoms. The granular cell tumor is rare tumor with the uncertain histogenesis and shows greater predilection for the oral cavity.
VASCULAR LEIOMYOMA: A RARE CASE REPORT IN THE BUCCAL MUCOSA. JAQUELINE LEMES RIBEIRO, FERNANDA HERRERA DA COSTA, RENATA MENDONCA ¸ MORAES, ANA SUELI RODRIGUES CAVALCANTE, ESTELA KAMINAGAKURA TANGO, YASMIN RODARTE CARVALHO and, ANA LIA ANBINDER Angioleiomyoma is a benign neoplasm with perivascular smooth muscle origin and is rare in the mouth. A male patient presented to our service with the chief complaint of an asymptomatic facial lesion. In the intraoral examination, a 1.5-cm submucosal nodule in the left cheek was observed. Doppler ultrasonography showed an image of a lobulated, hyperechoic nodule with defined limits and no change in the blood flow. The clinical hypotheses were lipoma, solitary fibrous tumor, and salivary gland neoplasm. Histologic examination after excisional biopsy revealed a delimited lesion, presenting multiple vascular spaces of varying sizes and calibers, sometimes congested and interconnected, covered by endothelium and spindle cell layers of variable thickness. A mixed thrombus with an organization area composed of granulation tissue was also found. Neoplastic cells were immunoreactive for smooth muscle actin and negative for CD34, confirming the diagnosis of angioleiomyoma. After 6 months of follow-up, no signs of recurrence were observed.
GIANT CELL TUMOR IN SINUS MAXILLARY AND NASAL CAVITY: A RARE CASE REPORT. BRENDO VINICIUS RODRIGUES LOUREDO, GERSON DE OLIVEIRA PAIVA NETO, ELIANDRO DE SOUZA FREITAS, FRANCISCO AMADIS BATISTA TATIANA NAYARA FERREIRA, FABIO ARRUDA BINDA, ^ LIBORIO-KIMURA and, JECONIAS CAMARA