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SIMPLE BONE CYST: TREATMENT AND FOLLOW-UP OF 24 MONTHS
ABSTRACTS
e54
HENRIQUE LOPES DOMINGUETE, LUCIANA YAMAMOTO ALMEIDA, LUCAS RIBEIRO TEIXEIRA, KAMILA PRADO PEREIRA GRACIANO, JOSE DIAS DA SILVA-NETO and, JORGE ESQUICHE LEON Epidermoid cysts (ECs) are rare and occur in the head and neck region with an incidence from 1.6% to 7%. In the oral cavity, EC represents less than 0.01% of all cysts. To date, approximately 80 EC cases have been reported. We report a case of a 26-year-old man who developed a large EC in the midline floor of the mouth, leading to speech and swallowing difficulties and causing swelling in the submental region. Ultrasonography and fine needle aspiration confirmed the cystic nature of the lesion. The lesion was surgically excised by intraoral approach, and microscopically revealed an EC associated with extensive elastofibromatous changes in the cystic capsule. The pathogenesis of the abnormal deposition of elastic fibers is unknown; however, degenerative phenomenon, disturbed production, genetic predisposition, or trauma have been considered. To the best of our knowledge, this is the first report of elastofibromatous changes in an intraoral EC.
A CASE REPORT OF CRANIOFACIAL FIBROUS DYSPLASIA. MARIANA SATURNINO DE NORONHA, CAMILA DE NAZARE ALVES DE OLIVEIRA KATO, FELIPE PAIVA FONSECA and, RICARDO ALVES MESQUITA Craniofacial fibrous dysplasia (CFD) is a nonneoplasic lesion, characterized by the substitution of normal osseous tissue by proliferating fibrous stroma and immature bone tissue. CFD usually occurs by 10 years of age and the progression commonly manifests in adulthood. A 20-year-old male patient presented with a painless enlargement in the maxilla with indeterminate evolution time. Clinical examination revealed a swelling extending to the right side of maxilla and orbital floor. Radiographic aspects showed borders contiguous with normal adjacent bone and a ground-glass appearance. Incisional biopsy was performed. Microscopic examination showed lamellar bone trabeculae, varied in size, arranged parallel to fibrous connective tissue, compatible with benign fibro-osseous lesion. Multiplane sections on cone beam computed tomography showed an extensive orbital floor and maxillary involvement and increased dimensions of the occiput, base of the skull, hard palate, and zygoma. A final diagnosis was craniofacial fibrous dysplasia. Patient is under followup care and will undergo corrective surgery. Support: FAPEMIG.
GINGIVAL SQUAMOUS CELL CARCINOMA AND ENVIRONMENTAL RISK FACTORS LEONARDI, FOR ORAL CANCER. NICOLAS JUAN IGNACIO PANICO, GERARDO GILLIGAN and, RENE LUIS PANICO The aim of this work is to present a case of a 74-year-old man who visited the Oral Medicine Department, Dentistry College, at the Catholic University of Cordoba with a gum lesion involving the lower incisors and the left canine. During oral examination, a gingival mass with an ulcerated surface of 6 months’ duration was noted. The lesion had a history of painless growth and displayed no dental mobility, however, it did exhibit a slight tendency to bleed. The patient was born and lived in a village near Cordoba, Argentina, which is characterized by arsenic contamination of groundwater. Classic risk factors for oral cancer such as tobacco consumption and alcohol were not found.
OOOO January 2020 Oral squamous cell carcinoma was diagnosed after an incisional biopsy. Arsenic, classified by the International Agency for Research on Cancer as a human chemical carcinogen, is present in groundwater of some regions of South America and it could have contributed to oral carcinogenesis as in this case.
OSTEOMYELITIS IN A PATIENT WITH PYCNODYSOSTOSIS: A RARE CASE REPORT AND REVIEW OF THE LITERATURE. JOSE ALCIDES ALMEIDA DE ARRUDA, EDUARDO MORATO DE OLIVEIRA, POLIANNE ALVES MENDES NASCIMENTO, LAUREN FRENZEL SCHUCH, AMALIA MORENO, LEANDRO NAPIER DE SOUZA and, RICARDO ALVES MESQUITA Pycnodysostosis (PYCD) is a rare autosomal recessive disease occurring due to a mutation in the gene that codes for the enzyme cathepsin K. Osteomyelitis of the jaws is a common complication of the PYCD. A 30-year-old female patient with PYCD presented with mandibular osteomyelitis which was treated by sequestrectomy and with a buccal fat pad as free graft (BFPFG) to fill the bone defect. The 24-month of follow-up demonstrates clinical and radiographic healing. A literature search was undertaken in Medline (through PubMed) in March of 2018 on PYCD case reports. Seventeen contributions were included in this study and discussed. To the best of our knowledge, this is the first case using BFPFG in the management of osteomyelitis of the jaws in a patient with PYCD. Despite the good results, further studies using BFPFG as adjuvant therapy for the management of jaw osteomyelitis are necessary to elucidate its clinical efficiency and safety. Support: FAPEMIG.
A CUSTOM-MADE OCULAR PROSTHESIS FOR A PATIENT AFFECTED BY HERPES ZOSTER: A CASE REPORT. LARISSA SANTOS FARIA, LUISA FERNANDES MONKEN, LUIZA VALE COELHO, MATHEUS SILVA COSTA, JOSE ALCIDES ALMEIDA ARRUDA, RICARDO ALVES MESQUITA and, AMALIA MORENO The ocular prosthesis functions to repair a loss or deformity of the ocular globe. Prosthetic rehabilitations destined for anophthalmic cavities that suffered cicatricial retraction represent a challenge during fabrication since they often need to be reduced due to atrophy of the cavity and simultaneously need to have a good aesthetic appearance regarding contour and artificial iris. This report describes an unusual ocular prosthetic rehabilitation of a 77-year-old patient with an atrophic anophthalmic cavity due to herpes zoster induced loss. The steps in the creation of the ocular prosthesis involved cavity impression, artificial iris painting, wax adaptation, and laboratory processing and installation. The treatment focus included: comfort and adaptation during use, satisfactory retention, good aesthetic appearance, and achievement of total eye closure while wearing the ocular prosthesis. There was reestablishment of facial harmony and, consequently, maintenance of the functional and anatomic integrity of the cavity after a follow-up period of 6 months. Support: FAPEMIG.
SIMPLE BONE CYST: TREATMENT AND FOL^ LOW-UP OF 24 MONTHS. SAMILA GONCALVES ¸ BARRA, ALESSANDRO OLIVEIRA DE JESUS, ISADORA PEREIRA GOMES,
OOOO Volume 129, Number 1 CAMILA DE NAZARE ALVES DE OLIVEIRA KATO, FELIPE PAIVA FONSECA and, RICARDO ALVES MESQUITA Simple bone cyst (SBC) is a common benign osseous lesion comprised of an empty or semi-empty cavity within the bone of unknown etiology. A 15-year-old white male patient was referred to an oral diagnostic service for evaluation of a mandibular asymptomatic lesion. The previous medical history was unremarkable. Clinical examination didn’t show facial swelling or an expansile buccal surface of the mandible. The mucosa showed no abnormalities. Panoramic radiography revealed a welldefined, unilocular, radiolucent lesion measuring 20 £ 20 mm and extending from tooth 43 to tooth 45. There was no root resorption or tooth displacement. Fine-needle aspiration was negative for liquid. Curettage was performed under local anesthesia and the tissue specimen reveled vascularized connective tissue with hemorrhagic areas. The final diagnosis was SBC. The patient remains under 24 months of observation and presents no signs of recurrence. Support: FAPEMIG
PHLEBOLITHS ASSOCIATED WITH VASCULAR MALFORMATION IN THE JUGAL ^ MUCOSA. SAMILA GONCALVES ¸ BARRA, CAMILA DE NAZARE ALVES DE OLIVEIRA KATO, FELIPE PAIVA FONSECA, CLAUDIA BORGES BRASILEIRO, ^ TANIA MARA PIMENTA AMARAL, TARCILIA APARECIDA DA SILVA and, RICARDO ALVES MESQUITA Stagnation of blood flow and thrombosis in vascular malformation (VM) have been known to cause phlebolith formation. The symptoms of VM with phleboliths are pain, stasis, swelling, and foreign body sensation. A 48-year-old white woman was referred to an oral diagnostic service presenting with swelling and pain in the face close to the right parotid gland. Clinical examination showed the presence of multiple nodules with poorly defined limits, with a mobile and rigid consistency in the region of the right buccal mucosa. Panoramic radiography demonstrate multiple lesions which were well delimited and of different sizes; further, they were radiopaque with a radiolucent halo area extending from the coronoid process area to the mandibular base. An x-ray with periapical film of the buccal mucosa on the right side was performed and the image was similar to panoramic view. Ultrasonography examination was requested and revealed a low-flow vascular abnormality in the region. The patient was referred to the vascular surgeon. Support: FAPEMIG.
RESECTION OF AN EXTENSIVE MAXILLARY AMELOBLASTOMA THROUGH A MIDFACIAL DEGLOVING APPROACH: A CASE REPORT. EDUARDO MORATO DE OLIVEIRA, MAICON FRANCIS DE PAIVA, POLIANNE ALVES MENDES, PATRICIA CARLOS CALDEIRA, RICARDO ALVES MESQUITA, MARIA CASSIA FERREIRA DE AGUIAR and, LEANDRO NAPIER DE SOUZA An 81-year-old male patient was referred to the stomatology service complaining of difficulty in prosthesis adapting. Clinically, a painless swelling was evident in the left maxilla. An incisional biopsy was performed and the specimen sent for histopathologic examination, revealing a final diagnosis of ameloblastoma. A computerized tomography (CT) scan was performed, revealing an
ABSTRACTS
e55
extensive left maxillary lesion, involving the maxillary sinus and nasal cavity, crossing the midline and extending to the right side. During surgical planning, the use of the Weber-Ferguson-Diffenbach approach was raised, but it would not allow the recommended resection of the lesion since it exceeded past the midline. So, a midfacial degloving approach was chosen because this allows complete resection with safety margin and a better aesthetic result. The patient recovered well with good healing; no signs of recurrence were noted after 1 year of follow-up care. Thus, the degloving approach should be taken into account when treating extensive lesions in the midface. Support: FAPEMIG.
NASOPALATINE DUCT CYST: A CASE REPORT. JULIANA BIANCHI SOUZA DOS PASSOS, JOSE ALCIDES ALMEIDA DE ^ ARRUDA, LENI VERONICA DE OLIVEIRA SILVA, WAGNER HENRIQUES DE CASTRO, FELIPE EDUARDO CAMPOS BAIRES, FELIPE PAIVA FONSECA and, RICARDO ALVES MESQUITA Nasopalatine duct cyst is the most common nonodontogenic cyst of the jaws. The cyst is believed to arise from rests of the nasopalatine duct epithelium. A 59-year-old white female patient was attended by the oral pathology service to evaluate painful swelling in the anterior palate. Intraoral examination showed an erythematous 1.5 £ 1.5 cm nodule in the anterior edentulous palate. Occlusal and periapical radiographs showed a well-defined, unilocular, radiolucent image with a size of 1.5 £ 1.5 cm, near to the midline of the anterior palate. Surgical excision was performed and the specimen revealed a fragment of cystic capsule lined with stratified squamous epithelium with areas of cuboid simple epithelium. The cystic capsule was composed by dense fibrous connective tissue, showing a chronic inflammatory infiltrate and large blood vessels. The diagnosis was nasopalatine duct cyst. The postoperative course was uneventful, and no signs of recurrence have been noted 7 months later. Support: FAPEMIG.
MULTIPLE ANGIOSARCOMAS IN THE GINGIVA. GABRIELA FURIAN TRAMA, LUISA AGUIRRE BUEXM, MIRIAM BEATRIZ e MOREIRA SARRUF, ADRIANA TEREZINHA JORDAO NEVES NOVELLINO ALVES, LUCIANA WERNERSBACH PINTO, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ and, JOSIANE COSTA RODRIGUES DE SA A 56-year-old white woman complained of "bleeding gum lesions." Previous medical history revealed systemic arterial hypertension, diabetes mellitus, cardiac arrhythmia, and surgery for a prosthetic heart valve placement. Oral examination showed 3 pedunculated nodules in the gingiva involving the 3 remaining upper teeth, about 1.5 cm in greatest diameter, with rapid growth and bleeding but otherwise asymptomatic. Diagnostic hypothesis was pyogenic granuloma. Complete blood count showed leukopenia and thrombocytopenia. Excisional biopsy of 1 of the nodules was performed with local hemostatics agents, after medical consultation. Histopathologic analysis was suggestive of malignant mesenchymal neoplasm with histogenesis to be elucidated. Immunohistochemical study was positive for CD31 and negative for human herpesvirus 8 (HHV-8), S-100, p63, and AE1/AE3. The final diagnosis was angiosarcoma. During the investigation process, the patient experienced significant bone pain and worsening of her general condition, resulting in an emergency
e54
HENRIQUE LOPES DOMINGUETE, LUCIANA YAMAMOTO ALMEIDA, LUCAS RIBEIRO TEIXEIRA, KAMILA PRADO PEREIRA GRACIANO, JOSE DIAS DA SILVA-NETO and, JORGE ESQUICHE LEON Epidermoid cysts (ECs) are rare and occur in the head and neck region with an incidence from 1.6% to 7%. In the oral cavity, EC represents less than 0.01% of all cysts. To date, approximately 80 EC cases have been reported. We report a case of a 26-year-old man who developed a large EC in the midline floor of the mouth, leading to speech and swallowing difficulties and causing swelling in the submental region. Ultrasonography and fine needle aspiration confirmed the cystic nature of the lesion. The lesion was surgically excised by intraoral approach, and microscopically revealed an EC associated with extensive elastofibromatous changes in the cystic capsule. The pathogenesis of the abnormal deposition of elastic fibers is unknown; however, degenerative phenomenon, disturbed production, genetic predisposition, or trauma have been considered. To the best of our knowledge, this is the first report of elastofibromatous changes in an intraoral EC.
A CASE REPORT OF CRANIOFACIAL FIBROUS DYSPLASIA. MARIANA SATURNINO DE NORONHA, CAMILA DE NAZARE ALVES DE OLIVEIRA KATO, FELIPE PAIVA FONSECA and, RICARDO ALVES MESQUITA Craniofacial fibrous dysplasia (CFD) is a nonneoplasic lesion, characterized by the substitution of normal osseous tissue by proliferating fibrous stroma and immature bone tissue. CFD usually occurs by 10 years of age and the progression commonly manifests in adulthood. A 20-year-old male patient presented with a painless enlargement in the maxilla with indeterminate evolution time. Clinical examination revealed a swelling extending to the right side of maxilla and orbital floor. Radiographic aspects showed borders contiguous with normal adjacent bone and a ground-glass appearance. Incisional biopsy was performed. Microscopic examination showed lamellar bone trabeculae, varied in size, arranged parallel to fibrous connective tissue, compatible with benign fibro-osseous lesion. Multiplane sections on cone beam computed tomography showed an extensive orbital floor and maxillary involvement and increased dimensions of the occiput, base of the skull, hard palate, and zygoma. A final diagnosis was craniofacial fibrous dysplasia. Patient is under followup care and will undergo corrective surgery. Support: FAPEMIG.
GINGIVAL SQUAMOUS CELL CARCINOMA AND ENVIRONMENTAL RISK FACTORS LEONARDI, FOR ORAL CANCER. NICOLAS JUAN IGNACIO PANICO, GERARDO GILLIGAN and, RENE LUIS PANICO The aim of this work is to present a case of a 74-year-old man who visited the Oral Medicine Department, Dentistry College, at the Catholic University of Cordoba with a gum lesion involving the lower incisors and the left canine. During oral examination, a gingival mass with an ulcerated surface of 6 months’ duration was noted. The lesion had a history of painless growth and displayed no dental mobility, however, it did exhibit a slight tendency to bleed. The patient was born and lived in a village near Cordoba, Argentina, which is characterized by arsenic contamination of groundwater. Classic risk factors for oral cancer such as tobacco consumption and alcohol were not found.
OOOO January 2020 Oral squamous cell carcinoma was diagnosed after an incisional biopsy. Arsenic, classified by the International Agency for Research on Cancer as a human chemical carcinogen, is present in groundwater of some regions of South America and it could have contributed to oral carcinogenesis as in this case.
OSTEOMYELITIS IN A PATIENT WITH PYCNODYSOSTOSIS: A RARE CASE REPORT AND REVIEW OF THE LITERATURE. JOSE ALCIDES ALMEIDA DE ARRUDA, EDUARDO MORATO DE OLIVEIRA, POLIANNE ALVES MENDES NASCIMENTO, LAUREN FRENZEL SCHUCH, AMALIA MORENO, LEANDRO NAPIER DE SOUZA and, RICARDO ALVES MESQUITA Pycnodysostosis (PYCD) is a rare autosomal recessive disease occurring due to a mutation in the gene that codes for the enzyme cathepsin K. Osteomyelitis of the jaws is a common complication of the PYCD. A 30-year-old female patient with PYCD presented with mandibular osteomyelitis which was treated by sequestrectomy and with a buccal fat pad as free graft (BFPFG) to fill the bone defect. The 24-month of follow-up demonstrates clinical and radiographic healing. A literature search was undertaken in Medline (through PubMed) in March of 2018 on PYCD case reports. Seventeen contributions were included in this study and discussed. To the best of our knowledge, this is the first case using BFPFG in the management of osteomyelitis of the jaws in a patient with PYCD. Despite the good results, further studies using BFPFG as adjuvant therapy for the management of jaw osteomyelitis are necessary to elucidate its clinical efficiency and safety. Support: FAPEMIG.
A CUSTOM-MADE OCULAR PROSTHESIS FOR A PATIENT AFFECTED BY HERPES ZOSTER: A CASE REPORT. LARISSA SANTOS FARIA, LUISA FERNANDES MONKEN, LUIZA VALE COELHO, MATHEUS SILVA COSTA, JOSE ALCIDES ALMEIDA ARRUDA, RICARDO ALVES MESQUITA and, AMALIA MORENO The ocular prosthesis functions to repair a loss or deformity of the ocular globe. Prosthetic rehabilitations destined for anophthalmic cavities that suffered cicatricial retraction represent a challenge during fabrication since they often need to be reduced due to atrophy of the cavity and simultaneously need to have a good aesthetic appearance regarding contour and artificial iris. This report describes an unusual ocular prosthetic rehabilitation of a 77-year-old patient with an atrophic anophthalmic cavity due to herpes zoster induced loss. The steps in the creation of the ocular prosthesis involved cavity impression, artificial iris painting, wax adaptation, and laboratory processing and installation. The treatment focus included: comfort and adaptation during use, satisfactory retention, good aesthetic appearance, and achievement of total eye closure while wearing the ocular prosthesis. There was reestablishment of facial harmony and, consequently, maintenance of the functional and anatomic integrity of the cavity after a follow-up period of 6 months. Support: FAPEMIG.
SIMPLE BONE CYST: TREATMENT AND FOL^ LOW-UP OF 24 MONTHS. SAMILA GONCALVES ¸ BARRA, ALESSANDRO OLIVEIRA DE JESUS, ISADORA PEREIRA GOMES,
OOOO Volume 129, Number 1 CAMILA DE NAZARE ALVES DE OLIVEIRA KATO, FELIPE PAIVA FONSECA and, RICARDO ALVES MESQUITA Simple bone cyst (SBC) is a common benign osseous lesion comprised of an empty or semi-empty cavity within the bone of unknown etiology. A 15-year-old white male patient was referred to an oral diagnostic service for evaluation of a mandibular asymptomatic lesion. The previous medical history was unremarkable. Clinical examination didn’t show facial swelling or an expansile buccal surface of the mandible. The mucosa showed no abnormalities. Panoramic radiography revealed a welldefined, unilocular, radiolucent lesion measuring 20 £ 20 mm and extending from tooth 43 to tooth 45. There was no root resorption or tooth displacement. Fine-needle aspiration was negative for liquid. Curettage was performed under local anesthesia and the tissue specimen reveled vascularized connective tissue with hemorrhagic areas. The final diagnosis was SBC. The patient remains under 24 months of observation and presents no signs of recurrence. Support: FAPEMIG
PHLEBOLITHS ASSOCIATED WITH VASCULAR MALFORMATION IN THE JUGAL ^ MUCOSA. SAMILA GONCALVES ¸ BARRA, CAMILA DE NAZARE ALVES DE OLIVEIRA KATO, FELIPE PAIVA FONSECA, CLAUDIA BORGES BRASILEIRO, ^ TANIA MARA PIMENTA AMARAL, TARCILIA APARECIDA DA SILVA and, RICARDO ALVES MESQUITA Stagnation of blood flow and thrombosis in vascular malformation (VM) have been known to cause phlebolith formation. The symptoms of VM with phleboliths are pain, stasis, swelling, and foreign body sensation. A 48-year-old white woman was referred to an oral diagnostic service presenting with swelling and pain in the face close to the right parotid gland. Clinical examination showed the presence of multiple nodules with poorly defined limits, with a mobile and rigid consistency in the region of the right buccal mucosa. Panoramic radiography demonstrate multiple lesions which were well delimited and of different sizes; further, they were radiopaque with a radiolucent halo area extending from the coronoid process area to the mandibular base. An x-ray with periapical film of the buccal mucosa on the right side was performed and the image was similar to panoramic view. Ultrasonography examination was requested and revealed a low-flow vascular abnormality in the region. The patient was referred to the vascular surgeon. Support: FAPEMIG.
RESECTION OF AN EXTENSIVE MAXILLARY AMELOBLASTOMA THROUGH A MIDFACIAL DEGLOVING APPROACH: A CASE REPORT. EDUARDO MORATO DE OLIVEIRA, MAICON FRANCIS DE PAIVA, POLIANNE ALVES MENDES, PATRICIA CARLOS CALDEIRA, RICARDO ALVES MESQUITA, MARIA CASSIA FERREIRA DE AGUIAR and, LEANDRO NAPIER DE SOUZA An 81-year-old male patient was referred to the stomatology service complaining of difficulty in prosthesis adapting. Clinically, a painless swelling was evident in the left maxilla. An incisional biopsy was performed and the specimen sent for histopathologic examination, revealing a final diagnosis of ameloblastoma. A computerized tomography (CT) scan was performed, revealing an
ABSTRACTS
e55
extensive left maxillary lesion, involving the maxillary sinus and nasal cavity, crossing the midline and extending to the right side. During surgical planning, the use of the Weber-Ferguson-Diffenbach approach was raised, but it would not allow the recommended resection of the lesion since it exceeded past the midline. So, a midfacial degloving approach was chosen because this allows complete resection with safety margin and a better aesthetic result. The patient recovered well with good healing; no signs of recurrence were noted after 1 year of follow-up care. Thus, the degloving approach should be taken into account when treating extensive lesions in the midface. Support: FAPEMIG.
NASOPALATINE DUCT CYST: A CASE REPORT. JULIANA BIANCHI SOUZA DOS PASSOS, JOSE ALCIDES ALMEIDA DE ^ ARRUDA, LENI VERONICA DE OLIVEIRA SILVA, WAGNER HENRIQUES DE CASTRO, FELIPE EDUARDO CAMPOS BAIRES, FELIPE PAIVA FONSECA and, RICARDO ALVES MESQUITA Nasopalatine duct cyst is the most common nonodontogenic cyst of the jaws. The cyst is believed to arise from rests of the nasopalatine duct epithelium. A 59-year-old white female patient was attended by the oral pathology service to evaluate painful swelling in the anterior palate. Intraoral examination showed an erythematous 1.5 £ 1.5 cm nodule in the anterior edentulous palate. Occlusal and periapical radiographs showed a well-defined, unilocular, radiolucent image with a size of 1.5 £ 1.5 cm, near to the midline of the anterior palate. Surgical excision was performed and the specimen revealed a fragment of cystic capsule lined with stratified squamous epithelium with areas of cuboid simple epithelium. The cystic capsule was composed by dense fibrous connective tissue, showing a chronic inflammatory infiltrate and large blood vessels. The diagnosis was nasopalatine duct cyst. The postoperative course was uneventful, and no signs of recurrence have been noted 7 months later. Support: FAPEMIG.
MULTIPLE ANGIOSARCOMAS IN THE GINGIVA. GABRIELA FURIAN TRAMA, LUISA AGUIRRE BUEXM, MIRIAM BEATRIZ e MOREIRA SARRUF, ADRIANA TEREZINHA JORDAO NEVES NOVELLINO ALVES, LUCIANA WERNERSBACH PINTO, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ and, JOSIANE COSTA RODRIGUES DE SA A 56-year-old white woman complained of "bleeding gum lesions." Previous medical history revealed systemic arterial hypertension, diabetes mellitus, cardiac arrhythmia, and surgery for a prosthetic heart valve placement. Oral examination showed 3 pedunculated nodules in the gingiva involving the 3 remaining upper teeth, about 1.5 cm in greatest diameter, with rapid growth and bleeding but otherwise asymptomatic. Diagnostic hypothesis was pyogenic granuloma. Complete blood count showed leukopenia and thrombocytopenia. Excisional biopsy of 1 of the nodules was performed with local hemostatics agents, after medical consultation. Histopathologic analysis was suggestive of malignant mesenchymal neoplasm with histogenesis to be elucidated. Immunohistochemical study was positive for CD31 and negative for human herpesvirus 8 (HHV-8), S-100, p63, and AE1/AE3. The final diagnosis was angiosarcoma. During the investigation process, the patient experienced significant bone pain and worsening of her general condition, resulting in an emergency