Angioleiomioma oral mimetizando um granuloma piogênico: relato de caso raro / Oral Angioleiomyoma mimetizing a pyogenic granuloma: A rare case report

Angioleiomioma (AL) é um tumor benigno de origem perivascular que raramente é observado na cavidade oral, principalmente em localizações como a gengiva. Devido sua apresentação clínica inespecífica, os ALs podem mimetizar outras lesões orais, como tumores benignos de glândulas salivares e lesões reacionais, como o granuloma piogênico. O presente artigo objetiva relatar um caso raro de AL localizado em gengiva, em uma paciente de 19 anos. Clinicamente, a lesão apresentava-se como um tumor assintomático, oval, pedunculado, bem definido, com superfície lisa, consistência fibrosa e cor eritematosa, semelhante a um granuloma piogênico, Uma biópsia excisional foi realizada e o fragmento foi encaminhado para análise histopatológica, que revelou uma proliferação vascular de diversos calibres, contendo paredes musculares espessas e proliferação muscular adjacente, além de infiltrado inflamatório, predominantemente crônico, hemácias extravasadas e área de ulceração, consistente com o diagnóstico de AL inflamado. A histopatologia desempenha um papel importante no diagnóstico final de lesões raras e com características clínicas inespecíficas. A excisão cirúrgica da lesão é o tratamento de escolha mais eficaz para os ALs orais. (AU)

Angioleiomyoma (AL) is a benign tumor of smooth muscle of perivascular origin that is rarely seen in the oral cavity, mainly in locations like the gingiva. Due to their nonspecific clinical presentation, ALs can mimic other oral lesions, such as benign salivary gland tumors and reactional lesions, as a pyogenic granuloma. We reported a case of an AL located in the gingiva in a 19-year-old female patient. In clinical terms, the lesion was presented as an asymptomatic, oval, pedunculated, well-defined nodule with a smooth surface, fibrous consistency and erythematous color, similar to a pyogenic granuloma. An excisional biopsy was performed and the fragment was sent for histopathological analysis that revealed a vascular proliferation of different calibers, containing thick muscle walls and adjacent muscle proliferation, in addition to an inflammatory infiltrate, predominantly chronic, extravasated red blood cells and an area of ulceration, consistent with the diagnosis of inflamed AL. The histopathology plays an important role in the final diagnosis of rare lesions and with nonspecific clinical characteristics. The surgical excision of the lesion is the most effective treatment of choice for oral ALs. (AU)

Épulis congénito: reporte de un caso clínico / Congenital epulis: clinical case study / Epúlide congênita: relato de caso clínico

El épulis congénito es una patología neonatal muy rara. Se trata de un tumor benigno pediculado de la mucosa de los maxilares, más frecuentemente localizado en maxilar superior en relación 2-3/1. Se describe el caso de un recién nacido de sexo femenino, de término, adecuado, vigoroso. Se constata al nacimiento la presencia de un épulis congénito que causa alteraciones de la succión. Se realiza intervención quirúrgica temprana, con resolución de la patología sin complicaciones.

Congenital epulis is a very rare neonatal pathology. It is a benign pedunculated tumor of the jaw mucosa, most frequently located in the upper jaw in a 2-3 / 1 ratio. The case of a newborn, female, term, adequate, vigorous is described. Noting at birth a congenital Epulis that causes suction alterations. Early surgical intervention is perfomed with resolution of the pathology without complications.

A epúlide congênita é uma patologia neonatal muito rara. É um tumor pedunculado benigno da mucosa dos maxilares, mais frequentemente localizado no maxilar superior na proporção de 2-3/1. Descreve-se o caso de um recém-nascido, do sexo feminino, a termo, adequado, vigoroso. Verificando ao nascimento uma Epúlide congênita que causa alterações na sucção. A intervenção cirúrgica precoce é realizada com resolução da patologia sem complicações.

Late Diagnosis of Oral Melanoma / Diagnóstico Tardío de Melanoma Oral

ABSTRACT: Oral melanoma (OM) is an extremely rare and aggressive malignancy. A 67-year-old patient presented with complains of a slightly symptomatic spot in the mouth since the past 2 years. Extraoral examination revealed left cervical lymphadenopathy, and intraoral examination a blue-black multinodular sessile mass, with irregular margins, involving the attached gingiva of teeth 27 and 28, extending to vestibular sulcus and hard palate, measuring approximately 3.5 cm. The lesion presented focal areas of ulceration. Panoramic radiograph did not show bone involvement. The main diagnostic hypothesis was oral melanoma. Microscopic findings of the incisional biopsy revealed a proliferation of densely pigmented pleomorphic cells, invading the subepithelial connective tissue in sheets or nests showing an organoid pattern. Immunopositivity for S-100, Melan-A and HMB-45 confirmed the diagnosis of melanoma. The patient was referred to an oncology hospital in which multiple metastases were detected, and the patient was subjected to palliative care. Herein we report an OM in advanced clinical stage, and discuss the clinical, morphological and immunohistochemical diagnostic criteria with emphasis on the importance of early diagnosis.

RESUMEN: El melanoma oral (MO) es una malignidad extremadamente rara y agresiva. Un paciente de 67 años acudió a consulta con la queja de una mancha intraoral ligeramente sintomática, presente desde hace dos años. Al examen clínico extraoral, se encontró adenopatía cervical del lado izquierdo, y al examen intraoral, se observó una masa sésil multinodular de color negro azulado, focalmente ulcerada, con bordes irregulares, afectando la encía de los dientes 27 y 28, extendiéndose hasta el surco vestibular y el paladar duro, midiendo aproximadamente 3,5 cm. La radiografía panorámica no mostró involucramiento óseo. La principal hipótesis diagnóstica fue MO. Los hallazgos microscópicos de la biopsia incisional revelaron una proliferación de células pleomórficas densamente pigmentadas, invadiendo difusamente el tejido conectivo en forma de sábanas o nidos con patrón organoide. La positividad inmunohistoquímica para S-100, Melan-A y HMB-45 confirmó el diagnóstico de melanoma. El paciente fue referido a un hospital oncológico, en el cual se le detectaron múltiples metástasis y fue sometido a cuidados paliativos. Este es el reporte de un caso de MO diagnosticado en estado avanzado, en el que se discuten los criterios clínicos, morfológicos e inmunohistoquímicos para su diagnóstico, haciendo énfasis en la importancia del diagnóstico temprano.

Fibroma odontogénico periférico: reporte de un caso / Peripheral odontogenic fibroma: case report

El Fibroma Odontogénico Periférico fue definido por la OMS en el año 2005 como una neoplasia benigna rara constituida por tejido fibroso maduro y una cantidad variable de epitelio odontogénico inactivo. Dada su presentación clínica, localización y baja prevalencia suele ser mal diagnosticado como una lesión reaccional. Se presenta un caso clínico de fibroma odontogénico periférico tratado mediante remoción quirúrgica y se realiza una revisión de la bibliografía respecto a la patología con el propósito de esclarecer algunos aspectos de esta lesión, además de incluirla dentro de los posibles diagnósticos diferenciales de lesiones reaccionales gingivales. El objetivo del siguiente artículo es presentar un caso clínico de FOP tratado mediante remoción quirúrgica y aportar en el diagnóstico diferencial de las lesiones reaccionales gingivales.

Peripheral odontogenic fibroma was described by the World Health Organization (WHO) in 2005, as a rare benign tumor containing mature fibrous connective tissue with a varying amount of inactive odontogenic epithelium. Though its clinical presentation, localization and low prevalence, it tends to be misdiagnosed as a reactive lesion. We present a case report of a Peripheral Odontogenic Fibroma treated by surgical resection and a narrative review of the literature with the purpose of clarifying different aspects of this lesion besides considering it as a possible differential diagnosis of reactive gingival lesions. The purpose of this article is to present a case report of peripheral odontogenic fibroma treated by surgical resection. Also to contribute to the differential diagnosis of gingival reactive lesions.

Congenital epulides: A rare case report.

Congenital epulis (CE) or “Granular cell epulis” also previously termed as “Neumann’s tumor” is a benign growth arising from the mucosa of the gingiva, typically seen as a mass protruding from the infant’s mouth, often interfering with respiration and feeding. These tumors generally present as a single mass arising from the upper alveolus. We report a rare case of two congenital epulides arising from the maxillary and mandibular alveolus in a day old female infant, which was surgically excised, allowing for early initiation of breast feeding. The tumor cells stained negative for S100 protein hence differentiating from other granular cell tumors. The clinical presentation, differential diagnosis in regard to the various neonatal oral swellings and the management of CE has been discussed.

Peripheral ossifying fibroma: A case report / Fibroma osificante periférico: Reporte de un caso

Peripheral ossifying fibroma (POF) is a relatively uncommon gingival growth that is considered to be reactive in nature and appear secondary to irritation or trauma. It presents as an exophytic growth with smooth surface. POF in older age group, observance of calcification in radiograph of excised specimen, pathologic migration, mobility and size greater than 2 cm is an occasional entity. The article presents such a rare case of POF in a 60-year-old female patient which was treated by surgical excision. This case contradicts the logic that this lesion occurs in teenagers and in second and third decades of life

El fibroma osificante periférico (FOP) es un crecimiento gingival poco común, considerado reactivo por su naturaleza y en general se manifiesta secundario a una irritación o trauma y se presenta como un crecimiento exofítico de superficie lisa. En grupos de mayor edad, el FOP muestra calcificación radiográfica, migración patológica, movilidad y un tamaño mayor de 2 cm, es de carácter ocasional. Se presenta un caso raro de FOP en una paciente de 60 años que fue tratado mediante excisión quirúrgica. Este caso, contradice su lógica de aparición en adolescentes o adultos entre la segunda y tercera década de la vida

Extranodal Nasal NK/T-Cell Lymphoma: A Rare Oral Presentation and FASN, CD44 and GLUT-1 Expression

Extranodal natural killer (NK)/T-cell lymphoma is an aggressive malignant tumor with distinctive clinicopathological features, characterized by vascular invasion and destruction, prominent necrosis, cytotoxic lymphocyte phenotype and a strong association with Epstein-Barr virus. Here is reported an extranodal nasal NK/T-cell lymphoma case, involving the maxillary sinus, floor of the orbit, and interestingly extending to the oral cavity through the alveolar bone and buccal mucosa, preserving the palate, leading to a primary misdiagnosis of aggressive periodontal disease. Moreover, this work investigated for the first time the immunohistochemical expression of fatty acid synthase (FASN) and glucose transporter 1 (GLUT-1) proteins in this neoplasia. FASN showed strong cytoplasmatic expression in the neoplastic cells, whereas GLUT-1 and CD44 were negative. These findings suggest that the expression of FASN and the loss of CD44 might be involved in the pathogenesis of the extranodal nasal NK/T-cell lymphoma, and that GLUT-1 may not participate in the survival adaptation of the tumor cells to the hypoxic environment. Further studies with larger series are required to confirm these initial results.

O linfoma de células natural killers (NK)/T extranodal é um tumor maligno agressivo com características clinicopatológicas distintas, caracterizadas por invasão e destruição vasculares, necrose proeminente, fenótipo linfocítico citotóxico e uma forte associação com o vírus Epstein-Barr. Relatamos aqui um caso de linfoma de células NK/T nasal extranodal, envolvendo o seio maxilar, assoalho de órbita, e interessantemente estendendo-se para a cavidade oral através do osso alveolar e mucosa vestibular, preservando o palato, levando a um diagnóstico inicial equivocado de doença periodontal agressiva. Ainda, nós investigamos pela primeira vez a expressão imunoistoquímica das proteínas Fatty acid sinthase (FASN) e glucose transporter 1 (GLUT-1) nesta neoplasia. FASN revelou uma forte expressão citoplasmática nas células neoplásicas, enquanto GLUT-1 e CD44 foram negativas. Estes achados sugerem que a expressão de FASN e a perda de CD44 podem estar envolvidas na patogênese do linfoma de células NK/T nasal extranodal, e que GLUT-1 não deve participar da adaptação das células tumorais ao ambiente de hipóxia. Estudos adicionais com séries maiores são necessários para confirmar nossos resultados iniciais.

Peripheral squamous odontogenic tumor.

A case of peripheral squamous odontogenic tumor is described in a 60-year-old female who presented with a sessile growth in the right posterior mandible. Radiographic examination revealed no evidence of a central lesion in bone. With the characteristic histopathological picture of benign-appearing islands of squamous epithelium scattered randomly against a background of mature fibrous connective tissue, the tumor was diagnosed as peripheral squamous odontogenic tumor (PSOT). The epithelial islands showed peripheral cuboidal or flattened cells, microcyst formation, individual cell keratinization, and keratin pearl formation.

Plasmablastic extramedullary plasmacytoma.

Extramedullary plasmactyoma is the solitary, soft tissue form of plasma cell neoplasm but lack the defining features of medullary or multiple myeloma. The diagnosis is difficult to make in routine practice setting due to the morphological and immunohistochemical overlap with plasmablastic lymphoma. We report a case of plasmablastic extramedullary plasmacytoma in a 52-year-old in the mandibular lingual gingiva and discuss its differential from plasmablastic lymphoma. The gingival mass regressed with primary radiotherapy.

A nodular growth on maxillary gingiva.

A case of angiosarcoma of maxilla is presented. The occurrence of angiosarcoma in the oral cavity is a rare incidence and maxilla is one of the rarest sites to be involved. The purpose of this article is also to emphasize the fact that sometimes small, innocent-looking masses in the oral cavity might actually turn out to be a highly destructive malignant tumor. Hence, a complete radiographic and histopathologic examination is mandatory.

Isolated relapse in the oral cavity of a child with t-lineage acute lymphoblastic leukemia

Despite high cure rates, approximately 20% of patients with acute lymphoblastic leukemia (ALL) have disease relapse. Isolated recurrence in oral cavity is extremely unusual. The aim of this paper is to report a case of an isolated relapse occurred in a child with T-lineage ALL. Clinical picture included swelling and pain in the right upper gingiva of the oral cavity, with no other clinical or hematological alterations. Diagnosis was confirmed by biopsy and immunohistochemical staining. Bone marrow aspiration was normal. Five months later leukemic infiltration of the bone marrow was detected and systemic chemotherapy was reintroduced. This case report highlights the relevance of dental care during and after chemotherapy, not only to treat lesions in the oral cavity resulting from the disease itself or from treatment side effects, but also to detect unusual sites of ALL relapse.

Apesar dos altos índices de cura, cerca de 20% dos pacientes com leucemia linfóide aguda (LLA) apresentam recidiva da doença. Recidiva isolada na cavidade oral é extremamente incomum. O objetivo deste trabalho é relatar um caso de recidiva isolada em criança com LLA de linhagem T. A apresentação clínica foi quadro de edema e dor na cavidade oral, na região superior da gengiva à direita, sem outras alterações clínicas ou hematológicas. O diagnóstico foi confirmado por meio de biópsia e imuno-histoquímica. O mielograma era normal. Cinco meses após a manifestação inicial na cavidade oral, foi detectada infiltração leucêmica na medula óssea. O tratamento com quimioterapia sistêmica foi reintroduzido. Este relato de caso ressalta a importância do acompanhamento clínico e odontológico durante e após o tratamento quimioterápico, não somente com o objetivo de tratar as alterações na cavidade oral decorrentes da própria doença ou dos efeitos adversos do tratamento, mas para que sejam detectadas apresentações incomuns de recidiva na LLA.

Epulis congénito del recién nacido: tratamiento y evolución. Presentación de un caso clínico / Congenital epulis in a newborn child: treatment and evolution. Presentation of a clinical case

El épulis congénito del recién nacido es un tumor benigno pedunculado que aparece en la cavidad bucal de los infantes, pudiendo tener varios tamaños. Es más frecuente en el sexo femenino y se localiza preferentemente en el reborde alveolar del maxilar superior y con menor prevalencia en el maxilar inferior. Se presenta un paciente sexo femenino recién nacido, con tumoración en encía que recubre parte del maxilar inferior. Se describe su seguimiento y control a largo plazo por algunos años.

Gingival Granular Cell Lesion-Congenital Epulis.

Gingival granular cell tumour or congenital epulis is a rare benign soft tissue tumour that occurs mostly over lateral alveolar ridge of maxilla. The lesion behaves in a benign manner with spontaneous regression and without any recurrence or metastasis. We hereby report a case of congenital epulis in a 5 weeks old, baby girl who presented with single sessile mass over right side of maxillary alveolar ridge since birth; and want to emphasize that although rare this entity should always be considered in differential diagnosis of neonatal lesions of the oral cavity.

Ameloblastic fibro-odontoma of the anterior mandible in a 22-month-old boy.

We report an ameloblastic fibro-odontoma (AFO) presenting in the anterior mandible as a "bump on his gums" in a 22-month-old boy. An occlusal radiograph revealed a well-circumscribed radiolucency with scattered radiopaque foci. The tumor was enucleated under general anesthesia. The histologic findings were characteristic of an AFO, a mixed odontogenic tumor most common in the posterior jaws, primarily affecting individuals with an average age of 10 years. The clinical presentation, microscopic findings, differential diagnoses, and treatment are discussed.

Cowden syndrome.

Cowden syndrome or multiple hamartoma syndrome is an autosomal dominant condition with variable expressions that result mainly from mutation in the PTEN gene on arm 10q. It is characterized by multiple hamartomatous neoplasms of the skin, oral mucosa, gastrointestinal tract, bones, CNS, eyes, and genitourinary tract. Mucocutaneous features include trichilemmomas, oral mucosal papillomatosis, acral keratosis, and palmoplantar keratosis. Here we present a case of Cowden syndrome in a 14-year-old female patient with the chief complaint of multiple oral papillomatous lesions.

Granuloma piógeno: reporte de un caso / Pyogenic granuloma: a case report

El Granuloma Piógeno (Granuloma Telangiectásico) es un agrandamiento gingival de aspecto tumoral, se caracteriza por ser muy vascularizado, no purulento; puede producirse como respuesta a un trauma menor, su etiología no se relaciona con microorganismos infecciosos. Se localiza en cualquier área de la mucosa bucal, es más común en la encía marginal-vestibular de los dientes anteriores del maxilar. Aportar evidencias clínicas sobre la epidemiología y diagnóstico de ésta patología. Se reporta el caso de un paciente masculino de 48 años de edad, procedente de El Vigía - Estado Mérida, que acude a la Cátedra de Periodoncia (F.O.U.L.A). Al examen clínico presentó una lesión en la encía marginal-vestibular del 21, de forma ovoide, con 5 mm de diámetro, consistencia blanda, textura rugosa, base sésil, color rojizo, crecimiento lento e indoloro, y de 18 meses de evolución. Radiográficamente no se evidenciaron alteraciones en el periodonto de inserción. Se realizó extirpación quirúrgica de la lesión y posterior análisis histopatológico de la muestra. Las características histopatológicas de la muestra confirman la presencia de un Granuloma Piógeno; se reporta un postoperatorio satisfactorio sin recidiva. La literatura señala que esta lesión es común en niños y mujeres embarazadas, sin embargo, el caso reportado se trata de un paciente masculino de 48 años, por lo tanto se puede decir que, el Granuloma Piógeno puede estar presente en personas de cualquier edad y genero, razón por la cual se deben conocer las características clínicas de ésta lesión y los diagnósticos diferenciales de la misma

Pyogenic Granuloma (Telangiecticum Granuloma) is an gingival tumour was characterised by highly vascularized, this is not purulent, may occur in response to minor trauma, its etiology is not related to infective microorganisms. Pyogenic Granuloma could be localised in any area of the oral mucosa is more common in the marginal gingiva, buccal maxillary anterior teeth. To provide clinical evidence on the epidemiology and diagnosis of this condition. We report a case of a male patient age 48, from El Vigia - Mérida State, attending the Department of Periodontics (Foula). At clinical examination he presented a lesion in the marginal gingiva of 21, an ovoid form, with 5 mm in diameter, soft, rough texture, sessile base, reddish, slow growth, painless and 18 months of evolution. Radiographically, showed not alterations in the periodontium of insertion. We performed surgical excision of the lesion and subsequent histological analysis of the sample. The histopathological characteristics of the sample confirmed the presence of a Pyogenic Granuloma; we report a satisfactory postoperative without recurrence. The literature suggests that this injury is common in children and pregnant women, however, the reported case was a male patient of 48 years, therefore we can say that Pyogenic Granuloma can occur in people of any age and sex, For these reason is very important that the dentist knows about clinical characteristics the differential diagnosis of this lesión

Congenital epulis: a case report

Congenital epulis is a rare lesion of the newborn. A case of congenital epulis is presented here with details on the clinical, histopathological characteristics as well as the management of the lesion

Extramedullary plasmacytoma of the gingiva

Extramedullary plasmacytoma is defined as neoplastic proliferation of plasma cells in soft tissue. It accounts for up to 3% of all plasma cell tumors. Approximately, 90% of extramedullary plasmacytomas are found in the head and neck region commonly modality of treatment with or without adjuvant chemotherapy. We report a case of extramedullary plasmacytoma of the gingiva

Malignant melanoma of the oral cavity.

Oral malignant melanoma is a rare disease. The common sites of its occurrence are the palate and gingiva with the maxillary arch being affected 80% of the time. Because of their presence at relatively obscure areas in the oral cavity, most of the malignant melanomas of the oral cavity are diagnosed at a late stage. These lesions are associated with poor prognosis. The dental clinician must therefore carefully examine the head, neck, and oral cavity, and any pigmented lesion that may exhibit growth potential must be biopsied. This article describes a case of malignant melanoma that was present in the oral cavity and briefly reviews the relevant literature that explains the nature of this lesion.

Plasma cell granuloma of gingiva.

An exceedingly rare case of gingival plasma cell granuloma is reported in a 40-year old female patient. The case presented as an exophytic mass of gingiva, clinically resembling traumatic fibroma. Histopathologic findings revealed dense sheets of plasma cells infiltrate. Immunohistochemistry for kappa and lambda light chains showed polyclonal (benign) staining pattern confirming a diagnosis of plasma cell granuloma. It is important to recognise this peculiar lesion because of its highly unusual incidence in involving the periodontium. Clinical features are usually suggestive of traumatic fibroma (benign) but histopathologicaly in early stages it closely resembles plasmacytoma (malignant). This case highlights the need to biopsy unusual lesions to rule out potential neoplasms and also emphasizes the need to submit all the excised tissue for histological examination regardless of clinical impression and/or perceived surgical success. Only by such practice can rare lesion of this type be diagnosed and their incidence studied.