The importance of the dentist in the diagnosis of cowden syndrome – Case report

Cowden Syndrome is an autosomal dominant disorder characterized by the development of several hamartomas in a variety of tissues, including the skin, gastrointestinal tract, adipose tissue, and bone and connective tissues. This syndrome is associated with a high risk of developing malignancies, especially breast, thyroid and endometrium cancers. This report presents a case of a 53-year-old patient who sought assistance at the Dentistry Department of the University Hospital of Brasilia (HUB) to receive basic dental treatment. The current and past medical history and oral and facial manifestations led to the diagnosis of Cowden syndrome. This case report aims to highlight the importance of a dental surgeon in the diagnosis of this syndrome, based on the observation of oral manifestations and medical history.

A Síndrome de Cowden é uma desordem hereditária autossômica dominante, caracterizada pelo desenvolvimento de diversos hamartomas em vários tipos de tecidos, incluindo a epiderme, trato gastrointestinal, tecido adiposo e tecidos ósseo e conjuntivo. Essa síndrome é associada a um risco elevado de desenvolvimento de malignidades, especialmente câncer de mama, tireoide e endométrio. Esse relato apresenta o caso de um paciente de 53 anos de idade que procurou o Departamento de Odontologia do Hospital Universitário de Brasília (HUB) para tratamento dental básico. História médica atual e passada e manifestações orais e faciais levaram ao diagnóstico de síndrome de Cowden. Este relato de caso apresenta a importância do cirurgião-dentista no diagnóstico desta síndrome, com base na observação das manifestações orais e história médica.

Oral cancer staging established by magnetic resonance imaging

The aim of this study was to compare clinical staging and magnetic resonance imaging (MRI) staging for oral cancer, and to assess inter-observer agreement between oral and medical radiologists. A total of 10 patients diagnosed with oral cancer were assessed before treatment. A head and neck surgeon performed clinical TNM staging. Two medical radiologists and two oral radiologists performed a new staging assessment by interpreting MRI scans, without prior knowledge of the clinical staging. They evaluated the extent of the primary tumor (T), metastasis to regional lymph nodes (N) and grouping by stages. The data were analyzed using the Kappa Index. There was significant agreement (p < 0.05) between the clinical and MRI staging assessments made by one oral radiologist for N stage, and between those made by one medical radiologist for the T and N stages and for the grouping by stages. In the MRI assessment, there was significant agreement among all four observers for both T stage and grouping by stages. For the N stage, there was no significant agreement between one oral radiologist and one medical radiologist or between both medical radiologists. There was significant agreement among the remaining radiologists. There was no agreement between the clinical and MRI staging. These results indicate the importance of using MRI for the diagnosis of oral cancer. Training initiatives and calibration of medical and oral radiologists should be promoted to provide an improved multidisciplinary approach to oral cancer.

Ressonância magnética no diagnóstico do câncer de boca: revisão da literatura e relato de caso / MRI in the diagnosis of mouth cancer: review and case report

OBJETIVO: Revisar a literatura concernente à utilização da ressonância nuclear magnética no estadiamento do câncer de boca e apresentar caso de neoplasia maligna onde a RNM contribuiu para a detecção da lesão em tecidos moles. RESULTADO E DISCUSSÃO: A RNM é a ferramenta de imagem que evolui com maior rapidez em diagnóstico na área de saúde. Suas vantagens principais são a alta resolução dos tecidos moles e ausência de risco biológico aos pacientes. Com estas qualidades, pode ser usada para detalhar a anatomia, permitindo melhor estadiamento das lesões no câncer bucal, contribuindo igualmente para o diagnóstico precoce de possíveis recidivas. No caso apresentado(neoplasia maligna de pequeno tamanho), a RNM contribuiu para a detecção da lesão em tecidos moles, na extensão da lesão e no planejamento cirúrgico.

OBJECTIVE: To review the literature about cancer staging by using magnetic resonance image (MRI) and to present a case to illustrate the utility of this image diagnosis tool. RESULTS AND DISCUSSION: MRI is the fastest evolving imaging tool for diagnosis in health area. Its main advantages include a high detail resolution soft tissue and no biological risks to patients. Thus, it can be used to evaluate the detailed anatomy of structures, allowing better staging for treatment of patients with oral cavity cancer as well as better assessment of possible post-surgical treatment and/or radiotherapy changes. Early detection of relapses is also a key advantage, which might lead to appropriate monitoring, and protocols that could greatly improve patients’welfare. The present case study illustrates the difference between the CT scan and MRI in the analysis of a small lesion, where CT scan yielded no information on clinical staging while MRI was decisive in the soft tissue injury view, extent of lesion and adequate surgical planning.

Periostite proliferativa associada a dens in dente

Proliferative periostitis is a disease characterized for successive deposition of layers of subperiosteal bone as a response reaction to a chronic inflammatory stimulation. The affected periosteum forms several rows of reactive bone that are parallel and expand the surface of the altered bone. Dens in dente is a developmental malformation resulting from invagination of the crown before calcification has occurred. They are usually diagnosed upon routine clinical and radiographic examination. An unusual case report of a mandibular dens in dente causing proliferative periostitis is presented. The source of infection was related to dens in dente in mandibular left second premolar's crown, which had apparently communication with periodontal tissues. It was successfully treated by surgical therapy with antibiotic duringthe treatment. After the extraction of the affected tooth, radiographic follow-up showed the decrease of proliferative periostitis, and remodelation of the cortical bone.

A periostite proliferativa é uma doença caracterizada por sucessivas deposições de camadas de osso subperióstica como resposta a um estímulo crônico inflamatório. O periósteo afetado forma sucessivas camadas de osso reacional paralelas entre si e expandem a superfície óssea nesse local. Dens in dente é uma alteração do desenvolvimento resultante de invaginação de esmalte para a dentina antes de sua calcificação ocorrer. Usualmente são diagnosticadas em exames clínicos-radiográficos de rotina. Um relato de caso clínico raro é apresentado sobre dens in dente na coroa do segundo pré-molar inferior causando periostite proliferativa. A fonte de infecção foi o dens in dente que tinha comunicação do meio bucal com a área do periodonto. Foi realizada a extração do dente anômalo associado com uso de antibióticos. As radiografias de controle mostraram diminuição da periostite proliferativa como remodelamento do osso cortical.

Radiografia panorâmica: instrumento auxiliar no diagnóstico da osteoporose: [revisão] / Panoramic radiograph: auxiliary tool in the diagnosis of osteoporosis: [review]

A osteoporose é considerada um problema de saúde pública pela Organização Mundial de Saúde (OMS). A identificação de indivíduos com baixa densidade mineral óssea e alto risco para fratura associada à osteoporose e o estabelecimento de estratégias específicas de prevenção de fraturas são o alicerce de qualquer programa preventivo de osteoporose. O passo seguinte a esse reconhecimento seria o encaminhamento destes indivíduos para realização de densitometria óssea, exame considerado padrão-ouro para o diagnóstico da doença. No entanto, o custo e a falta de acesso da população ao exame são fatores que dificultam a utilização da densitometria como método de rastreamento populacional para a osteoporose. A radiografia panorâmica é importante na rotina de pacientes idosos, particularmente antes da colocação de próteses totais e implantes em edêntulos. Existem medidas qualitativas e quantitativas realizadas nas radiografias panorâmicas, denominadas índices radiomorfométricos, que podem ser capazes de identificar mulheres na pós-menopausa com indicação de realização de densitometria óssea. O objetivo principal deste artigo é discutir a importância da radiografia panorâmica como ferramenta auxiliar no diagnóstico da osteoporose e de baixa densidade mineral óssea.

Osteoporosis is considered as a public health problem by World Health Organization. The identification of subjects at risk of fractures and with low bone mineral density is the basis of any preventive osteoporosis program. Then, high risk individuals should be referred for dual X-ray absorptiometry (DXA). DXA is considered the gold standard of bone mineral density assessment. Nevertheless, bone densitometry has a limited availability for routine use in population screening. Panoramic radiography is conducted routinely in elderly populations, especially for edentulous patients before treating with complete denture or implants. Some panoramic radiographic measurements, also known as panoramic radiomorphometric indices, may identify postmenopausal women that should perform bone densitometry. The main purpose of this paper is to discuss the importance of panoramic radiography as an auxiliary tool in the diagnosis of osteoporosis and low bone mineral density.