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)

Granuloma piógeno en el dorso lingual: caso clínico / Pyogenic granuloma in the lingual dorsum: a clinical case

El granuloma piógeno es una lesión benigna en la cavidad bucal, no neoplásica. Es una entidad fre- cuentemente asociada a la expansión de los tejidos blandos de la cavidad bucal. Se presenta, con mayor frecuencia, en individuos del género femenino, con edades comprendidas entre la segunda y cuarta década de vida. El tratamiento es mediante escisión quirúrgica con un pequeño margen de seguridad, y los agentes irritantes deben extraerse concomitan- temente para la curación de la lesión. Este trabajo tuvo como objetivo informar un caso de granuloma piógeno en el dorso de la lengua en una paciente del género femenino de 69 años. Los autores destacaron la importancia del conocimiento de la patología bucal por parte del Cirujano Dentista para poder realizar un correcto diagnóstico diferencial de otras lesiones, con el fin de realizar el tratamiento adecuado (AU)

Pyogenic granuloma is a quite common non-neoplasic benign lesion in the oral cavity. It is one of the entities most frequently associated with the soft tissues' expansion of the oral cavity, specifically in females, in the age group between the second and the fourth decade of life. The treatment is by surgical excision with a small margin of safety. For the healing of the lesion irritants should be concomitantly removed. This study aimed to report a case of pyogenic granuloma on the lingual dorsum of a 69-year-old female patient. The authors concluded highlighting the importance of the knowledge of oral pathology by the Dental Surgeon, to perform a correct differential diagnosis of other lesions to perform the appropriate treatment (AU)

Granuloma piógeno oral. Serie de casos / Oral pyogenic granuloma. Case series

RESUMEN El granuloma piógeno es una lesión que se manifiesta en la piel y en la cavidad oral, relacionado con diversas causas, como irritación crónica, trauma y cambios hormonales. Clínicamente se muestra como una lesión hiperplásica altamente vascularizada, con un tamaño de 1-3 cm, de base pedunculada o sésil y de crecimiento lento. Predomina en el sexo femenino y tiende a aparecer, sobre todo, en la encía, con muy pocos casos reportados en zonas edentes, motivo por el que se realizó el reporte de tres casos de granuloma piógeno oral en pacientes femeninas, comprendidas entre 30 y 40 años de edad. Se presentaron lesiones que diferían en cuanto a su localización y apariencia clínica (AU).

ABSTRACT Pyogenic granuloma is a lesion that arises in the skin and oral cavity, related to various causes, such as chronic irritation, trauma and hormonal changes. Clinically it looks like a highly vascularized hyperplastic lesion, sized 1-3 cm, with a pedunculated or sessile base and slow growing. It predominates in the female sex and tends to appear, above all, in the gum, with very few cases reported in edentulous areas; that is why the authors reported three cases of oral pyogenic granuloma in female patients, aged between 30 and 40 years. The lesions differed in their location and clinical appearance (AU).

Granuloma piógeno oral recurrente con pérdida ósea alveolar y movilidad dentaria: Reporte de un caso inusual / Granuloma piogênico oral recorrente com perda óssea alveolar e mobilidade dental: Relato de um caso incomum / Recurrent oral pyogenic granuloma with alveolar bone loss and tooth mobility: report of an unusual case

Resumen El granuloma piógeno oral es una lesión benigna multifactorial, caracterizada por presentarse como un agrandamiento gingival muy vascularizado. Se puede localizar en cualquier área de la cavidad oral, con más frecuencia en la encía marginal vestibular. Se presenta con mayor incidencia en mujeres adultas y en niños varones. No suele comprometer tejido óseo ni dientes y su tratamiento más seguro es la exéresis quirúrgica, siendo el riesgo de recurrencia alto. El objetivo del presente estudio es reportar el caso de una paciente de 9 años de edad, que fue sometida a la exéresis de un granuloma piogénico oral en el hueso maxilar y al año siguiente presentó una recurrencia de la lesión con pérdida ósea alveolar y movilidad de un diente adyacente. Se le realizó una biopsia y un curetaje minucioso, confirmándose el diagnostico de granuloma piogénico oral.

Resumo O granuloma piogênico oral é uma lesão multifatorial benigna, caracterizada por apresentarse como um aumento gengival altamente vascularizado. Pode estar localizado em qualquer área da cavidade oral, mais frequentemente na gengiva marginal vestibular. Ocorre com maior incidência em mulheres adultas e em crianças do sexo masculino. Geralmente não compromete o tecido ósseo ou os dentes e seu tratamento mais seguro é a escisão cirúrgica, sendo alto o risco de recorrência. O objetivo do presente estudo é relatar o caso de uma paciente de 9 anos de idade, submetida a escisão de granuloma piogênico oral no maxilar e no ano seguinte apresentou uma recorrência da lesão com perda óssea alveolar e a mobilidade de umo de seus dentes adjacentes. Uma biópsia e uma curetagem completa foram realizadas, confirmando o diagnóstico de granuloma piogênico oral.

Abstract Oral pyogenic granuloma is a benign multifactorial lesion that appears as a highly vascular gingival enlargement. It can be located anywhere in the oral cavity, most often in the vestibular marginal gingiva. It occurs most frequently in adult women and male children. It does not usually compromise bone tissue or teeth; its safest treatment is surgical excision, with a high recurrence risk. This study aims to report the case of a 9-year-old female patient who underwent oral pyogenic granuloma excision in the maxilla. The following year, she presented a possible lesion recurrence with alveolar bone loss and the mobility of an adjacent tooth. A biopsy and thorough curettage were performed, confirming the diagnosis of oral pyogenic granuloma.

Doença periodontal como fator determinante para a recidiva do granuloma piogênico / Periodontal disease as a determining factor for piogenic granumola recurrence

O presente estudo tem como objetivo descrever por meio de um caso clínico o diagnóstico e a conduta clínica no tratamento de um Granuloma Piogênico (GP) recidivante associado à doença periodontal. O GP é uma lesão inflamatória hiperplásica que se encontra nos tecidos moles da cavidade bucal e que possui um crescimento reagente estimulado por irritação local de baixa intensidade, fator hormonal ou trauma, podendo causar desconforto ao paciente e interferir na fala e mastigação. O GP acomete principalmente mulheres na segunda e terceira décadas de vida em regiões como gengiva, lábios, língua e mucosa bucal. O tratamento do GP consiste em excisão cirúrgica e o diagnóstico decisivo é realizado por meio de exame histopatológico. Paciente do gênero feminino, 57 anos, procurou atendimento no Centro Universitário da Serra Gaúcha ­ FSG por apresentar lesão rósea pediculada na região de papila incisiva com cerca de 2 cm de diâmetro. A paciente foi submetida a dois procedimentos cirúrgicos e em ambos ocorreu a recidiva. A completa excisão da lesão somente foi realizada após realização de tratamento periodontal e remoção de fatores irritantes como biofilme e cálculo dentário. Desta forma, foi possível concluir que é de suma importância a observação e remoção dos fatores irritantes durante o tratamento do GP e que desta maneira se diminuiu as chances de posterior recidiva(AU)

The present study aims to describe through a clinical case the diagnosis and clinical management treatment of a recurrent Piogenic Granuloma (GP) associated with periodontal disease. PG is a hyperplastic inflammatory lesion found in the soft tissues of the oral cavity and has a reactive growth stimulated by low intensity local irritation, hormonal factor or trauma, which may cause patient discomfort and interfere with speech and chewing. GP affects mainly women in the second and third decades of life in regions such as gums, lips, tongue and oral mucosa. The treatment of GP consists of surgical excision and the decisive diagnosis is made by histopathological examination. Female patient, 57 years old, attended the University Center of Serra Gaúcha - FSG presenting pediculated pink lesion in the incisive papilla region with about 2 cm in diameter. The patient underwent two surgical procedures and both relapsed. Complete excision of the lesion was only performed after periodontal treatment and removal of irritating factors such as biofilm and dental calculus. Thus, it was possible to conclude that the observation and removal of irritating factors during the treatment of GP is of paramount importance and thus reduced the chances of further relapse(AU)

Granuloma telangiectásico bucal / Oral telangiectatic granuloma

Introducción: el granuloma telangiectásico es un tumor reactivo inflamatorio en la cavidad bucal a causa de factores irritativos, traumafísico o factores hormonales. Es más frecuente en el sexo femenino entre la segunda y sexta décadas de la vida. Objetivo: describir los hallazgos clínico-patológicos del granuloma telangiectásico bucal, su posible patogénesis, diagnóstico diferencial y manejo terapéutico. Presentación de casos: se obtuvieron los datos de edad, género y diagnóstico clínico de una serie de cinco casos de granuloma telangiectásico bucal diagnosticados en la Facultad de Odontología de la Universidad de Cartagena entre el año 2016 y 2017. Se describen características clínicas, histológicas, factores etiológicos y sintomatología presentada en cada uno de ellos. El diagnóstico se realizó mediante histopatología y se confirmó como granuloma telangiectásico. En la totalidad de los casos el tratamiento realizado fue netamente quirúrgico. Conclusiones: es importante que los profesionales en odontología conozcan todos y cada uno de los aspectos relacionados con el granuloma telangiectásico, características clínicas, histológicas y los factores etiológicos, con el objeto de poder ofrecer un diagnóstico certero y, por consiguiente, un adecuado plan de tratamiento(AU)

Introduction: telangiectatic granuloma is an inflammatory reactive tumor of the oral cavity caused by irritating agents, physical trauma or hormonal factors. It is more frequent in the female sex between the second and sixth decades of life. Objective: describe the clinical-pathological findings of oral telangiectatic granuloma, as well as its possible pathogenesis, differential diagnosis and therapeutic management. Case presentation: data were obtained about the age, sex and clinical diagnosis of a series of five cases of oral telangiectatic granuloma diagnosed at the School of Dentistry of the University of Cartagena in the period 2016-2017. A description is provided of clinical and histological characteristics, etiological factors and symptoms of each case. Histopathology confirmed the diagnosis of telangiectatic granuloma. In all cases treatment was exclusively surgical. Conclusions: it is important for dental professionals to be aware of every single detail concerning telangiectatic granuloma, such as its clinical and histological characteristics and etiological factors, to be able to reach an accurate diagnosis and apply the appropriate therapy(AU)

Oral Adenosquamous Carcinoma Mimicking a Pyogenic Granuloma: a Challenging Diagnosis

Abstract Adenosquamous carcinoma is an aggressive variant of squamous cell carcinoma. This report describes a case of adenosquamous carcinoma with clinical features of a benign lesion and discusses the differential diagnoses, especially regarding histopathological and immunohistochemical analyses. A 45-year-old male was referred to our outpatient clinic complaining about a rapid-growing enlargement in hard palate. Clinical examination revealed an erythematous and pedunculated nodule with lobulated non-ulcerated surface. Excisional biopsy was performed following clinical diagnosis of pyogenic granuloma. Histologically, the specimen consisted of areas characterizing both well-differentiated squamous cell carcinoma and true adenocarcinoma. After a broad list of immunohistochemical markers was evaluated (AE1/AE3, CEA, CK5, CK7, CK8/18, p53, p63 and Ki67), the diagnosis of adenosquamous carcinoma was rendered and the patient referred to complementary surgery. Adenosquamous carcinoma represents a challenge in diagnostic routine due to its rarity, diverse range of clinical presentations and histological features. Furthermore, classical clinical benign features may be present in malignant lesions; hence the submission of every surgical specimen to histological analysis is mandatory to provide the patient the adequate treatment.

Resumo O carcinoma adenoescamoso é uma variante agressiva do carcinoma de células escamosas. Este relato descreve um caso de carcinoma adenoescamoso que apresenta características clínicas de uma lesão benigna e discute o diagnóstico diferencial, especialmente em relação à análise histopatológica e imuno-histoquímica. Um homem de 45 anos foi encaminhado ao nosso serviço queixando-se um aumento de volume de rápido crescimento no palato duro. O exame clínico revelou um nódulo eritematoso e pedunculado com superfície lobulada não ulcerada. Foi realizada biópsia excisional seguindo a hipótese clínica de granuloma piogênico. Histologicamente o fragmento consistia em áreas de carcinoma de células escamosas bem diferenciado e áreas de adenocarcinoma verdadeiro. Após a avaliação de uma ampla lista de marcadores imuno-histoquímicos (AE1/AE3, CEA, CK5, CK7, CK8/18, p53, p63 e Ki67), o diagnóstico de carcinoma adenoescamoso foi atribuído e o paciente foi encaminhado à cirurgia complementar. O carcinoma adenoescamoso representa um desafio na rotina de diagnóstico, devido à sua raridade, diversificada gama de apresentações clínicas e características histológicas. Além disso, características clínicas benignas podem estar presentes em lesões malignas, por isto a submissão de todas as peças cirúrgicas à análise histológica é obrigatória para fornecer ao paciente o tratamento adequado.

Pyogenic granuloma associated with mandibular odontoma / Granuloma piógeno asociado a odontoma mandibular

Background: pyogenic granuloma is a kind of inflammatory hyperplasia of multifactorial origin, which is usually related to trauma or constant irritation, drug use, hormonal factors, among others. Meanwhile the odontoma is a benign tumor odontogenic composed of epithelial and mesenchymal cells, their development is usually associated with trauma, infections, inherited disorders or hyperactivity odontoblast. Objectives: The objective is to present the clinical case of a patient that presented a case of pyogenic granuloma related to the presence of a mandibular odontoma, and therapeutic management and postoperative results. Case report: The case shows a female patient of 32 years old with a history of multinodular goiter and hypothyroidism, developing a mandibular odontoma of the left side associated with pyogenic granuloma in the same area, which was treated with surgical excision and reconstructed affected tissues with lyophilized bone and collagen membrane. Favorable outcome after surgery without evidence of recurrence, with proper osseointegration of alloplastic materials and soft tissues. Conclusions: The irritant effect of the presence of a tumor (odontoma) in developing confirmed pyogenic granuloma.

Antecedentes: el granuloma piógeno es una especie de hiperplasia inflamatoria de origen multifactorial, que suele relacionarse a trauma o irritaciones constantes, uso de drogas, factores hormonales, entre otras. Por su parte el odontoma es una tumoración odontogénica benigna, compuesta de células epiteliales y mesenquimatosas, su desarrollo suele relacionarse con traumatismos, procesos infecciosos, alteraciones hereditarias o hiperactividad odontoblástica. Objetivos. El objetivo es presentar el caso clínico de una paciente la cual presento un caso de granuloma piógeno relacionado a la presencia de un odontoma mandibular; así como el manejo terapéutico y los resultados posoperatorios. Caso clínico: El caso muestra a una paciente del sexo femenino de 32 años de edad con antecedentes de bocio multinodular e hipotiroidismo, desarrollando un granuloma piógeno asociado al desarrollo de un odontoma mandibular del lado izquierdo, el cual fue tratado con extirpación quirúrgica y los tejidos incidido reconstruidos con hueso liofilizado y membrana de colágeno. Evolución favorable pos quirúrgica, sin evidencia de recidiva, con correcta osteointegración de materiales aloplásticos y tejidos blandos. Conclusiones: se confirma el efecto irritante de la presencia de una tumoración (odontoma) en el desarrollo de un granuloma piógeno.

Granuloma telangiectásico en cavidad oral / Telangiecticum granuloma in oral cavity

El granuloma telangiectásico se considera como una lesión benigna no neoplásica de la mucosa gingival de tipo reactivo asociado a trauma. Durante varios años tuvo diferentes nombres dentro de los que destacan granuloma piógeno del embarazo o gravídico, hemangioma capilar lobular y épulis. Histológicamente se caracteriza por una proliferación vascular, infiltrado inflamatorio crónico y tejido de granulación. El objetivo del presente caso es describir las características clínicas e histológicas de un granuloma telangiectásico en cavidad oral y su plan de tratamiento. Llega a consulta paciente femenina de 50 años de edad, refiere presentar sangrado gingival en repetidas ocasiones en zona posterior de la arcada dentaria superior, durante el cepillado o con el consumo de algunos alimentos. Clínicamente se observa prótesis provisional desadaptada en órganos dentarios 11 al 15. Al retirar la prótesis es notorio un aumento de volumen en la encía interdental, con aspecto eritematoso, que sangra con facilidad. El reporte de anatomía patológica mostró una lesión con engrosamiento del epitelio escamoso, formación de nuevos vasos sanguíneos e infiltrado inflamatorio crónico. Diagnosticado como granuloma telangiectásico. La lesión fue eliminada quirúrgicamente por alargamiento coronal con reducción ósea. Ocho días después de la cirugía se evidencia proceso de cicatrización sin ninguna complicación. La lesión presentó recidiva transcurrido seis meses. Ello nos lleva a destacar la importancia del control de factores locales, como la presencia de prótesis desadaptadas y el acúmulo de placa bacteriana luego de la eliminación quirúrgica de este tipo de lesiones(AU)

Telangiectatic granuloma is a non-neoplastic benign lesion of the gingival mucosa, reactive type, associated with trauma. For several years, it had different names among which we can mention the pyogenic granuloma gravidarum occurring during pregnancy, the lobular capillary hemangioma and the epulis. Histologically, it is characterized by a vascular proliferation, chronic inflammatory infiltrate and granulation tissue. The aim of this case is to describe the clinical and histological characteristics of the telangiectatic granuloma of the oral cavity and its treatment plan. A 50-year-old female patient comes to the consultation reporting repeated gingival bleeding on the posterior area of the upper dental arch when brushing or consuming some food. Clinically, unadjusted provisional prosthesis was observed in the dental organs from 11 to 15. After removing the prosthesis, an increase in the volume of the interdental gum of erythematous type which bleeds easily was obvious. The pathologic report showed a lesion with swelling of the flaky epithelium, formation of new blood vessels and chronic inflammatory infiltrate. The diagnosis was telangiectatic granuloma. The lesion was surgically removed by crown lengthening with osseous reduction. Eight days after surgery, a healing process without complications was seen. 6 months later, the lesion relapsed. This fact leads us to outline the importance of the control of local factors, such as the presence of unadjusted prosthesis and the accumulation of dental plaque after the surgical removal of this type of lesions(AU)

Exposición espontánea de un torus palatino de la línea media / Spontaneous exposition of a midline palatal torus

Introducción. El torus , o rodete, palatino es una alteración ósea benigna que puede generar molestias en la fonación y en la deglución. Cuando su crecimiento o exposición persistente producen síntomas molestos, debe ser resecado quirúrgicamente. Presentación del caso. Se trata de una paciente de 82 años de edad, que consultó por una lesión ulcerativa de un año de evolución, que producía dolor, halitosis y molestia a la deglución. En el examen físico de la cavidad oral, se observó una prominencia de consistencia dura en la línea media, con perforación y ulceración de la mucosa palatina en su porción lateral posterior izquierda. Se consideraron los diagnósticos de torus palatino, osteoma, granuloma piógeno y neoplasia de tejidos blandos. Se decidió resecarla quirúrgicamente y hacer el estudio histopatológico. La evolución clínica fue satisfactoria, con resolución completa un mes después de la cirugía. En el estudio de histopatología se observó hiperostosis ósea con inflamación crónica de los tejidos blandos e hiperplasia simple de la mucosa, que corresponden a un torus palatino. Discusión. Se reporta un inusual caso de exposición espontánea de un torus palatino que ocupaba casi toda la bóveda palatina, se describe su resección quirúrgica y se informan los hallazgos de histopatología. En la revisión bibliográfica realizada, no se encontró un reporte previo de exposición espontánea de torus palatino.

Introduction: Palatal torus, or torus palatinus, is a benign bone alteration that may cause some discomfort during phonation or swallowing. When its growth or persistent exposition produces unpleasant symptoms, it must be surgically removed. Case presentation: We treated an 82-year-old female patient who consulted for a painful ulcerous lesion she had had for a year and which produced halitosis and discomfort when swallowing. During the oral cavity physical exam we observed a hard protuberance on the midline. It showed a perforation and ulceration of the lateral posterior palatal mucosa on the left side. We considered the following diagnosis: palatal torus, osteoma, pyogenic granuloma, or a soft-tissue neoplasia. We decided to surgically remove it and to perform a histopathological examination. Clinical evolution was satisfactory with complete resolution one month after surgery. The histopathological examination showed hyperostosis along with chronic inflammation of the soft tissues and a simple hyperplasia of the mucosa, which in turn indicated a palatal torus. Discussion: We report an unusual case of spontaneous exposition of a palatal torus which took up almost all of the hard palate area. Its resection is described and we inform the histopathological findings. In the literature review, we did not find a previous report of a spontaneous exposition of a palatal torus.

Concomitant occurrence of neurofibromatosis type I and lobular capillary hemangioma in the oral cavity: a case report

Neurofibromatosis type I is one of the most common autosomal dominant inherited disorders associated with deletion, insertion, or mutation in the NF-1 gene. Neurofibromas are the hallmark of the neurofibromatosis type I and usually appear during childhood or adolescence after the emergence of "caf‚ au lait" spots. Despite their occurrence in the head and neck region, neural sheath tumors are rarely seen in the oral cavity. Lobular capillary hemangioma is a histologic variant of pyogenic granuloma which is a common benign vascular lesion of the skin and mucosa. It is neither infective / purulent nor granulomatous as the name might suggest - rather a reactive enlargement that is an inflammatory response to local irritation. In the present study, we report a rare case of concomitant occurrence of neurofibromatosis type I and lobular capillary hemangioma in a fifteen-year-old Indian female who presented with a gingival overgrowth in her maxillary anterior region. The lesion was excised and histopathological report confirmed the diagnosis. To the best of our knowledge this is the first case in English literature where there was a parallel occurrence of neurofibromatosis type I and lobular capillary hemangioma in the oral cavity

Granuloma piogénico en la edad pediátrica: reporte de un caso / Pyogenic granuloma in children: a case report

Granuloma Piogénico (GP) es una lesión reactiva producida por un crecimiento excesivo del tejido conectivo, es frecuente en la mucosa bucal muy especialmente en el tejido gingival. Se trata de una patología de crecimiento rápido, sangrante y se asocia a la presencia de irritantes locales, microtraumatismos, entre otros factores. Tiene importante predilección por el género femenino entre la segunda y quinta década de la vida. Lesiones como malformaciones vasculares, lesión periférica de células gigantes y sarcoma de Kaposi son sus principales diagnósticos diferenciales y el tratamiento de elección es la escisión quirúrgica. A continuación se presenta un caso clínico poco común debido a las características clínicas de la lesión y la edad del paciente, pues se trata de un infante del género masculino de 5 años de edad, que acudió a la Facultad de Odontología de la UCV, referido por su odontólogo general, debido a la presencia de una lesión tumoral en el sector posterior derecho maxilar, adyacente a la cara distal del 55 de 2.5cm de tamaño. Se realizó la escisión quirúrgica de la lesión posterior a la evaluación de los exámenes preoperatorios y fue analizada histopatológicamente, donde se confirmó el diagnóstico inicial de GP

Pyogenic Granuloma (PG), is a reactive lesion caused by an excessive connective tissue growth and it frequently appears on oral mucosa, especially the gingiva. The PG present fast growth, bleeding propensity and it is associated, among other factors, to local irritation and minor trauma. It has predilection for female patients between second and fifth decade of life. The main differential diagnosis can be made with lesions such as: vascular malformations, peripheral giant-cell lesion and Kaposi's sarcoma. Surgical excision is the treatment of choice. This article presents a case report of an uncommon lesion regarding its rare clinical features and age of the patient. A 5 year old male patient who attended the Facultad de Odontología of Universidad Central de Venezuela, referred by his dental practitioner, presented a tumor-like lesion. The lesion was 2.5 cm in size and located on posterior right maxilla next to distal surface of 55. Surgical excision was performed after full laboratory test evaluation. The histopathology findings confirmed initial diagnose of PG

Granuloma piogênico em lábio inferior: uma localização incomum / Pyogenic granuloma on the lower lip: An unusual location

Pyogenic granuloma is a lesion characterized by excessive production of granulation tissue in response to trauma or chronic irritating stimulation. This pathological entity affects more often children and young adult females, being found mainly in the gum. Clinically, the lesions appear as smooth or lobulated red nodules with easy bleeding, occasionally ulcerated. The present work aims to report a case of pyogenic granuloma, emphasizing the clinical and pathologic features important for diagnosis.

Define-se granuloma piogênico como uma lesão reacional caracterizada pela produção excessiva de tecido de granulação em resposta a um trauma ou estímulo irritante crônico. Esta entidade patológica acomete, com maior frequência, crianças e adultos jovens do sexo feminino, sendo encontrada principalmente em gengiva. Clinicamente, as lesões apresentam-se como nódulos avermelhados, de fácil sangramento, com superfície lisa ou lobulada, ocasionalmente ulcerada. O presente trabalho tem por objetivo relatar um caso de granuloma piogênico de localização incomum, enfatizando os aspectos clínicos e histopatológicos importantes para o diagnóstico.

Granuloma piogénico de gran tamaño: reporte de un caso / Pyogenic granuloma: case report

El Granuloma Piogénico (GP) es una lesión no neoplásica de la cavidad bucal y de la piel relativamente poco frecuente y extremadamente rara en el tracto gastrointestinal. En la cavidad bucal donde es a menudo encontrada sobre tejido queratinizado. Se considera una hiperplasia inflamatoria. Clínicamente es una lesión uniforme o exofítica lobulada, pequeña, pápulas rojas eritematosas sobre una base pediculada o a veces sésil y que habitualmente sangra. El diámetro varía de pocos milímetros a varios centímetros. El propósito de este artículo es presentar un caso de Granuloma Piogénico, y valorar los factores que intervienen en su patogenia, así como la clínica, diagnóstico diferencial y tratamiento

Pyogenic granuloma (PG) is a non-neoplastic tumor lesion of the bucal cavity and skin relatively rare and extremely rare in the gastrointestinal tract. In the bucal cavity where it is often found on keratinized tissue. It is considered an inflammatory hyperplasia. Clinically it is an uniform or lobulated exophytic lesion, small, red erythematous papules on a pedunculated or sometimes sessile base that usually bleed. The diameter varies from a few millimeters to several centimeters. The purpose of this paper is to present a case of pyogenic granuloma, and evaluate the factors involved in its pathogenesis and the clinical differential diagnosis and treatment

Metástase cutânea rara de provável carcinoma basaloide de cólon simulando granuloma piogênico / Rare cutaneous metastasis from a probable basaloid carcinoma of the colon mimicking pyogenic granuloma

As acrometástases, principalmente para as mãos, são incomuns e representam cerca de 0,0070,2 por cento de todas as lesões metastáticas. O pulmão é o sítio de origem mais comum, colaborando com 4050 por cento dos casos relatados na literatura. Os rins e mamas são outras localizações também relacionadas a neoplasias que metastatizam para as mãos, além de, mais raramente, trato gastrointestinal, outros tumores sistêmicos e sarcomas. Seu diagnóstico precoce é difícil, pois pode ser assintomático, se assemelhar a tenossinovite, artrite, paroníquia, granuloma piogênico ou infecção local. No presente relato, os autores apresentam paciente com diagnóstico de acrometástase, em ambos os quartos quirodáctilos, oriunda de carcinoma basaloide de canal anal, com pobre resposta à radioterapia.

Acrometastasis is a rare occurrence, especially when affecting the hands. It represents around 0.007-0.2 percent of all metastatic lesions. The most common site of origin is the lung, accounting for 40-50 percent of all cases reported in the literature. Kidneys and breasts are other sites also associated with neoplastic lesions that disseminate to the hands. More rarely, the site of origin may be the gastrointestinal tract or other systemic tumors or sarcomas. Early diagnosis is difficult, since the condition may be asymptomatic or may mimic tenosynovitis, arthritis, paronychia, pyogenic granuloma or a local infection. In the present paper, the authors report on a patient with the diagnosis of acrometastasis on both hands originating from a basaloid carcinoma of the anal canal. Response to radiotherapy was poor.

Aggressive pregnancy tumor (Pyogenic Granuloma) with extensive alveolar bone loss mimicking a malignant tumor: case report and review of literature / Tumor agresivo del embarazo (Granuloma Piógeno) con gran pérdida del hueso alveolar simulando un tumor maligno: Reporte de caso y revisión bibliográfica

Oral pyogenic granuloma is a hyperplastic inflammatory lesion commonly associated to local irritation or trauma. Females are more affected than men probably due to the vascular effects of hormones that occur during puberty, pregnancy and menopause. In the pregnancy, the lesions are known as "pregnancy tumor" and tend to occur more frequently during the second and third trimester. In the oral cavity, histopathological examination is required for diagnosis, since the lesion is clinically indistinguishable from other reactive lesions and, usually, there is no evidence of bone involvement. The authors report a rare case of pyogenic granuloma with destruction of alveolar bone mimicking a malignant tumor in a 20-year-old woman in the 19th week of pregnancy.

El granuloma piógeno oral es una lesión hiperplásica inflamatoria asociada a la presencia de irritación local o trauma. Las mujeres son más afectadas que los hombres, probablemente debido a los efectos vasculares de las hormonas que se producen durante la pubertad, el embarazo y la menopausia. En el embarazo, las lesiones se conocen como "tumor del embarazo" y tienden a ocurrir con más frecuencia durante el segundo y tercer trimestres. En la cavidad oral, el examen histopatológico es necesario para el diagnóstico, ya que la lesión es clínicamente indistinguible de otras lesiones reactivas y, por lo general, no hay evidencia de afectación ósea. Los autores divulgan un caso raro de granuloma piógeno con la destrucción del hueso alveolar simulando un tumor maligno en una mujer de 20 años de edad, en la semana 19 de embarazo.

Processos proliferativos gengivais não neoplásicos em paciente sob tratamento ortodôntico / Non-neoplastic proliferative gingival processes in patients undergoing orthodontic treatment

INTRODUÇÃO: a aparatologia ortodôntica dificulta a higiene bucal e pode contribuir para a formação de lesões gengivais, como os processos proliferativos gengivais não neoplásicos. Essas lesões, dependendo de alguns fatores - como o tempo de evolução, constituintes histopatológicos e condições bucais -, podem ser reversíveis, em alguns casos, por meio da orientação sobre higiene bucal e da terapia periodontal básica. Entretanto, na maioria das vezes há necessidade de tratamento cirúrgico. OBJETIVO: o propósito deste trabalho é relatar o caso de uma paciente portadora de aparatologia ortodôntica fixa que apresentou duas lesões gengivais distintas, diagnosticadas como granuloma piogênico e hiperplasia gengival inflamatória. Foram discutidas as características clínicas e histopatológicas, incidência e frequência, modalidades terapêuticas e prevenção de ambas as lesões, demonstrando a importância do encaminhamento do material colhido ao exame histopatológico, dada a possibilidade de diversas hipóteses diagnósticas. Em ambas as lesões foi realizada a exérese cirúrgica. RESULTADOS: a lesão na arcada superior, diagnosticada como granuloma piogênico, apresentou recorrência, sendo necessária terapia periodontal básicae repetiçãodoprocedimento cirúrgico. Alesão na arcada inferior foi diagnosticada como hiperplasia gengival, sendo removida cirurgicamente e acompanhada clinicamente, com prescrição de orientação da higiene bucal ao paciente.

INTRODUCTION: Orthodontic appliances render oral hygiene difficult and may contribute to the development of gingival lesions such as non-neoplastic proliferative gingival processes. These lesions, depending on such factors as development time, histopathological components and oral conditions may be reversible in some cases - through oral hygiene advice and basic periodontal therapy. In most cases, however, surgical treatment is required. OBJECTIVES: The purpose of this paper is to report the case of a patient using fixed orthodontic appliance who presented with two distinct gingival lesions diagnosed as pyogenic granuloma and inflammatory gingival hyperplasia. The clinical and histopathological features, incidence and frequency, treatment modalities and prevention of both lesions were discussed, highlighting the importance of submitting the material collected from the lesions to histopathological examination given the possibility of different diagnostic hypotheses. Surgical excision was performed on both lesions. The upper arch lesion, diagnosed as pyogenic granuloma, relapsed, which led us to provide basic periodontal therapy and repeat the surgical procedures. RESULTS: The lesion in the lower arch, diagnosed as gingival hyperplasia, was surgically removed and followed up clinically, whereas the patient was instructed to perform proper oral hygiene.

Metastatic lung malignancy to mandibular gingiva.

Metastatic tumors of oral cavity are uncommon and may occur in oral soft tissues or jaw bones. Because of their rarity, metastasis to oral cavity are challenging to diagnose and difficult to treat. They often have vague symptoms that mimic dental infections. These lesions generally show poorly differentiated histopathologic picture and have poor prognosis. We reported a case of a 40-year-old male patient of metastatic lesion to the oral cavity and brain with primary tumor, diagnosed as an undifferentiated epithelial malignancy of lung.

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