Jordi | Journal of Oral DiagnosisOnline SubmissionReview an ArticleSOBEP - Sociedade Brasileira de Estomatologia e Patologia Oral
Current Number: V2 - 2017

Original Article

1 - Homeopathic treatment in oral lichen planus control: Case Report

Rafaela Savio Melzer B. F. Wastner; Fernando Luiz Zanferrari; Laurindo Moacir Sassi

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Lichen planus, considered an inflammatory disease of the stratified squamous epithelium of unknown aetiology, is a condition that often affects the oral mucosa. This pathology is more prevalent in female caucasian patients and the signs and symptoms range from asymptomatic to completely debilitating painful mucosal lesions. OBJECTIVE: To report a case of a patient affected by lichen planus, whose treatment was homeopathic. CASE REPORT: Female patient with pain complaints in oral mucosa and presence of whitish plaques in bilateral buccal mucosa that exacerbate during periods of stress. The lesions were controlled by homeopathy medication, which leaded to regression of the lesions and provided comfort to the patient. CONCLUSION: The use of homeopathy in Dentistry is a new concept, which has been growing and proving to be effective, especially when related to autoimmune diseases, where the stress is a factor linked to the development/ exacerbation of the signs and symptoms.

Keywords: Mouth; Homeopathy; Lichen Planus, Oral.

2 - Supernumerary bilateral tooth germs mimicking radiolucent bone pathology

Isadora Luana Flores1; Natanael de Alencar Samarcos Mahon2; Thiago de Oliveira Gamba3; Afonso Celso Assis2; Ana Paula Neutzling Gomes4; Sérgio Lúcio Pereira de Castro Lopes5

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The immature tissues of teeth germs may mimicking odontogenic and non-odontogenic lesions. About this, an asymptomatic bilateral well-circumscribed radiolucency found during the routine evaluation is considered an uncommon finding and both supernumerary and maxillomandibular bone pathologies should be listed. Quite often, it is one clinical exercise to suggest diagnostic hypotheses to unspecific radiolucency image since cysts, neoplasms and dental anomalies are possible. Here, we reported a case of bilateral supernumerary teeth germs in a 12-years-old Caucasian patient highly suspicious of bone pathology due to completely radiolucent aspect. So, this is the first article to presents a case of bilateral teeth germs as an alert to early stage of tooth crypts in the differential diagnosis of mandibular circumscribed radiolucencies.

Keywords: Tomography, X-Ray Computed; Tooth, Supernumerary; Tooth Germ..

3 - Management of oral adverse effects related to cetuximab plus radiotherapy

Danilo da Silva Corrêa; Thaís Feitosa Leitão de Oliveira; Paulo Sérgio da Silva Santos

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Squamous cell carcinomas of head and neck have an incidence of more than five hundred thousand cases a year worldwide. The standard treatment of this condition consists of platinum-based chemotherapy and radiotherapy. Nevertheless, in case of advanced age or reduced general condition the chemotherapy agent utilized is Cetuximab, a molecular targeted drug, used for metastatic colorectal cancer and head and neck cancer. Adverse effects associated with Cetuximab can be potentiated by the radiotherapy leading to oral mucositis and skin toxicities. We report a case of a 70-year-old caucasian woman who had removed a gingival squamous cell carcinoma at the left side of the mandible. During intensity modulated radiotherapy and Cetuximab chemotherapy she began to develop severe oral mucositis and perioral and neck skin toxicities. The pain associated with the oral mucositis prevented the patient from eating, causing a break in radio and chemotherapy. The treatment with systemic and topical medications and low-level lasertherapy was applied. The patient tolerated well the treatment and fifteen days after it began, radio and chemotherapy was reinitiated and concluded with no more adverse effects. It is important to the medical team to be aware of it, since the early identification and treatment of its signs and symptoms reduces the risks of breaks in the treatment and provides better quality of life to these patients.

Keywords: Antibodies, Monoclonal, Humanized; Cetuximab; Drug-Related Side Effects and Adverse Reactions; Mucositis..

4 - Surgical treatment of Schwannoma in lower lip: Case Report

Rafaela Savio Melzer; Vitor Hugo Candido Ferreira; Guilherme Klein Parise; Juliana Lucena Schussel; Laurindo Moacir Sassi

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INTRODUCTION: Of unknown aetiology, the schwannoma is a benign tumor that originates from the Schwann cells of the peripheral nerves. Around 25% to 45% of these tumors affect the head and neck region and are rare when affect the oral cavity. Presents itself as a lump of smooth surface, soft consistency and sessile. Histologically presents two standards, being the first known as Antoni A and the second, called Antoni B. OBJECTIVE: To present a case of schwannoma in lower lip. CASE REPORT: Male patient sought specialized care of a maxillofacial surgeon due to volume increase painless in lower lip. An incisional biopsy was performed and the diagnosis was of schwannoma. The lesion was removed in your entirety, the patient is well and no signs of recurrence. CONCLUSION: The schwannomas occur infrequently in head and neck region, and it is rare when the lip is the site of involvement. The treatment of choice is surgical excision.

Keywords: Schwann Cells; Lip; Neurilemmoma.

5 - Idiopathic Bilateral Central Giant Cell Granuloma of Jaw- A Case Report and Brief Review of Reported Cases

Aarfa Nasim; Ravi Prakash Sasankoti Mohan; Nagaraju Kamarthi; Vijay Wadhwan

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Central giant cell granuloma (CGCG) is a benign intraosseous reactive lesion of jaw with diverse clinical and radiological behaviour pattern. It accounts for 7% of neoplastic bone lesion of jaw with 70% occurring in mandible. CGCG was first considered as giant cell tumor mostly found in epiphyseal region of long bone having both aggressive and non-aggressive pattern. The etiology of the lesion is not defined. Multiple CGCGs of the jaw bones is very rare and, if it occurs, it is usually associated with hyperparathyroidism in majority of the cases. We report an interesting case in which a 33 year old female came with a swelling present on right side of mandible which was asymptomatic. Another swelling was present on left side which was non-evident and asymptomatic. Clinical, radiological and histopathological examination confirmed the lesions as central giant cell granuloma. Biochemical examination showed no signs of hyperparathyroidism. This report represents a very rare entity in which there is idiopathic bilateral CGCG having both aggressive and non-aggressive type of lesion.

Keywords: Giant Cells; Granuloma; Hyperparathyroidism; Mandible..

6 - Familial case of Gorlin-Goltz syndrome associated with craniosynostosis

Ravi Prakash Sasankoti Mohan; Akanksha Gupta; Nagaraju Kamarthi; Sangeeta Malik

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Gorlin-Goltz Syndrome is inherited as an autosomal dominant disorder and occurs due to mutations in the PTCH1 (Patched 1) gene. It is characterized by multiple keratocystic odontogenic tumors, multiple basal cell carcinomas, skeletal, ophthalmic, neurological abnormalities and facial dysmorphism. Craniosynostosis is the premature fusion of calvarial bones leading to an abnormal head shape. In addition to all the classical features, presence of craniosynostosis in one of our cases was an interesting finding which has never been reported previously in Gorlin-Goltz syndrome. Giant congenital melanocytic nevus was also present making the case more unique.

Keywords: Basal Cell Nevus Syndrome; Odontogenic Tumors; Nevus, Pigmented; Cranial Sutures..

Case Report

7 - Reemerging syphilis: diagnosis from oral lesions

Ingrid da Silva Santos1; Daniela Brito Bastos1; Vitor Bonetti Valente1; Solange Pires D'Ávila2; Kellen Cristine Tjioe1; Éder Ricardo Biasoli1; Glauco Issamu Miyahara1; Daniel Galera Bernabé1

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BACKGROUND: Syphilis cases have increasing worldwide recently, indicating a resurgence of the disease. Its clinical features vary widely and often challenge the establishment of the diagnosis. CASE REPORT: A 23-year-old woman presented with multiple erosive and patchy oral lesions, dysphagia, and pain with onset of two months. Her medical history revealed that she also presented skin macules which were misdiagnosed as pityriasis by a dermatologist. Nontreponemic test was reagent. An incisional biopsy of an oral lesion was performed and the histopathological aspects were suggestive of syphilis. Treponemic test was positive, confirming secondary syphilis. The treatment consisted of penicillin for 3 weeks. After the 6-months follow-up, clinical and serological exams did not show any sign of the disease. CONCLUSIONS: Diagnosing syphilis by oral lesions can be difficult once it can mimic other affections. Additionally, the reemergence of this sexually transmitted disease in the last years demands its inclusion in the differential diagnosis of either erosive or ulcerate lesions.

Keywords: Syphilis; Treponema pallidum; Diagnosis, Oral; Sexually Transmitted Diseases..

Original Article

8 - Clinical, morphological and immunohistochemical findings in canalicular adenoma

Leorik Pereira da Silva; Luiz Arthur Barbosa da Silva; Éricka Janine Dantas da Silveira; Patrícia Teixeira de Oliveira; Márcia Cristina da Costa Miguel

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Canalicular adenoma (CAd) is an uncommon benign salivary gland tumor, usually located in the upper lip. We carried out a survey of cases of CAds among the all salivary gland tumors submitted to an Oral Pathology service over a 36-year period, and performed a comprehensive literature review of all CAds reported from 2006 to 2016. Among 161 salivary gland tumors, only two were diagnosed as CAds. A detailed clinical, morphological and immunohistochemical (IHC) study of the two cases was performed. Morphologically, the tumors were characterized by cuboidal to columnar neoplastic cells lining cystic spaces and forming tumor cords. The IHC reactions (positive for cytokeratin-7, AE1/AE3, S-100, p63, and negative for α-SMA) supported a luminal/ductal cell proliferation without myoepithelial cells. The clinical features of the cases were similar to that shown in the literature, while the morphological and IHC findings confirmed the epithelial nature of the tumor, and highlighted important differential diagnostic aspects.

Keywords: Salivary Gland Neoplasms; Adenoma; Immunohistochemistry..

9 - Osteocartilaginous choristoma of the tongue: a case report and review of the literature

Priscilla Rodrigues Câmara1; Jefferson Ferreira dos Santos2; Maria Carolina de Lima Jacy Monteiro1; Rafaela Elvira Rozza de Menezes1; Adriele Ferreira Gouvêa1; Karla Bianca Fernandes da Costa Fontes1; Rebeca Souza Azevedo1; Renata Tucci1

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The purpose of the present article was to report a clinical case of a 53-year-old male patient with a tongue osteocartilaginous choristoma. Additionally, we made a brief review of the literature to identify all cases reported in English-language literature of oral osteocartilaginous choristoma and, to the best of our knowledge, there are only nine reported cases. Choristoma is a lesion characterized by the development of a histologically normal tissue in an abnormal site. Occurrence of osseous or cartilaginous choristomas in oral soft tissues are rather uncommon. Cases presenting both bone and cartilage simultaneously, named osteocartilaginous choristomas, are even rarer. After the literature search, we also compare the pathogenesis, clinical and histopathological features of our osteocartilaginous choristoma with the literature about osseous or cartilaginous choristomas. The present case report contributes with an additional case of osteocartilaginous choristoma of the tongue, which is suggestive of metaplasia, and it had an unusual histopathological aspect with cartilage structure as principal component.

Keywords: Choristoma; Diagnosis, Oral; Pathology..

10 - Evaluation of CD57+ cells in oral squamous cells carcinoma and their relationship with clinicopathological parameters

Maria Luiza Diniz de Sousa Lopes1; Caio César da Silva Barros2; Maurília Raquel de Souto Medeiros2; Márcia Cristina da Costa Miguel1; Lélia Batista de Souza1; Pollianna Muniz Alves3; Éricka Janine Dantas da Silveira1

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INTRODUCTION: The immune response occurring in the tumor microenvironment is very complex. Surface molecule CD57 can be expressed by natural killer cells and/or activated T lymphocytes, which are key cellular types in the cancer immunity. OBJECTIVES: This study investigated CD57 immunoexpression in immune cells of oral squamous cell carcinoma (OSCC) and verified its association with clinicopathological features. METHODS: Paraffin-embedded sections of 45 OSCCs were submitted to morphological and immunohistochemical analysis using anti-CD57 antibody. Relationship between the expression of CD57 and clinicopathological parameters (age, metastasis to regional lymph nodes, clinical stage and histopathological grade of malignancy) was verified by Pearson's Chi square, and Fisher exact statistical tests. RESULTS: The majority (64.4%) of the OSCCs analyzed affected subjects of male gender and over 40 years old (68.9%). There was a significant association between histological grade of malignancy and presence of lymph node metastasis, as well as clinical stage (p<0.05). CONCLUSIONS: The results suggest that CD57+ cells immune cells infiltration is a consistent finding in OSCC, regardless of clinicopathological features of these tumors.

Keywords: Mouth Neoplasms; Antigens, CD57; Immunohistochemistry.

11 - Trabecular juvenile ossifying fibroma in the mandible: clinical, radiographic and histopathologic features

Monica Ghislaine Oliveira Alves1; Bruna Fernandes do Carmo Carvalho2; André Caroli Rocha3; Carlos Ishida 4; Yasmin Rodarte Carvalho1; Janete Dias Almeida1

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Juvenile ossifying fibroma is an uncommon, aggressive, asymptomatic fibro-osseous lesion. An 11-year-old white boy was seen at the stomatology outpatient clinic with a complaint of pain and a one-year history of tooth mobility and extensive swelling in the mandible. Extraoral clinical examination showed major facial asymmetry and swelling in the left mandibular body. Intraoral examination revealed expansion of the buccal and lingual cortical bones. Imaging identified a multilocular mixed lesion in the mandible with hyperdense areas. An incisional biopsy was performed and the combination of clinical, imaging and histopathologic data led to the final diagnosis of juvenile ossifying fibroma. Treatment consisted of segmental mandibulectomy and reconstruction with a microsurgical fibular flap, after 5 years of follow up, no local recurrence was observed. Strategies for the clinical management and treatment of pediatric patient should be designed to offer the best prognosis and quality of life for the patient.

Keywords: Jaw Abnormalities; Jaw Diseases; Oral Medicine..

12 - Extensive osteolytic disease in the mandible of a pediatric patient: Case report

Tila Fortuna1; Deyvid Silva Rebouças2; Gabriela Santos Lopes3; Ana Carolina Lemos Pimentel1; Alena Ribeiro Alves Peixoto Medrado1,4; Carlos Elias de Freitas1,5

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INTRODUCTION: Gorham's disease, correspond to a massive osteolytic disease of the bones, characterized by destruction and resorption of one or more bones, spontaneous and progressive. The etiology of the disease is still unknown. The destroyed bone does not have the ability to regenerate or repair and is replaced by dense fibrous tissue. Bones of the skull and pelvis are the most commonly affected and in maxillofacial bones, the mandible is particularly affected. CASE REPORT: This study reports the case of an 11-year-old female, referred to the Oral and Maxillofacial Surgery service showing extensive area of spontaneous bone resorption, in which only the alveolar portion of the mandibular symphysis and the head of the left jaw were present. The history and clinical features observed indicated Gorham's disease. FINAL CONSIDERATIONS: When in progressive stages Gorham's disease is difficult to be diagnosed by histopathological evaluation, due to limited remaining bone quantity, leaving only clinical and complementary exams to make allowances. The treatment is controversial in the literature. Therapy is individualized in accordance with the severity of the patient's condition and the site of involvement.

Keywords: Bone Diseases; Pathology; Bone Resorption; Osteolysis, Essential..



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