Fibroma de Células Gigantes en Lactante Mayor / Giant Cell Fibroma in Older Infant. A Case Report

RESUMEN: El fibroma de células gigantes es considerado un tumor benigno no neoplásico de la mucosa oral. Este aparece en las primeras tres décadas de la vida, siendo relativamente raro en pacientes pediátricos. Puede encontrarse principalmente en la encía mandibular, mostrando predilección por el sexo femenino. Clínicamente se presenta como un crecimiento indoloro, de base sésil o pediculado, que generalmente se confunde con otras lesiones de tipo fibrosas como los fibromas de irritación. Histológicamente, se distingue por presentar fibroblastos estrellados con la presencia de células gigantes multinucleadas cerca de la lámina del epitelio. Presentamos el caso de una paciente femenino de un año de edad la cual presenta crecimiento nodular indoloro en relación con una superficie del paladar de 51 y 61. Teniendo en cuenta el tamaño y la ubicación de la lesión, se realizó escisión, biopsia y se envió para análisis histopatológico que confirmó la lesión como fibroma de células gigantes.

ABSTRACT: The giant cell fibroma is a benign nonneoplastic fibrous tumor of the oral mucosa. It occurs in the first three decades of life and is relatively rare in pediatric patients. It can be found predominantly in the mandibular gingiva, showing predilection for females. Clinically it presents as a painless, sessile, or pedunculated growth which is usually mistaken for other fibrous lesions like irritation fibroids. Histologically it is distinguished by the presence of stellated fibroblasts along with multinucleated giant cells near the epithelial sheet. We present a case where a one-year-old female patient presented with a painless nodular growth in relation to a palatesurface of 51 and 61. Considering the size and location of the lesion, excision and biopsy were performed and sent for histopathological analysis which confirmed the lesion as giant cell fibroma.

Gingival complex odontoma: a rare case report with a review of the literature

Odontomas are odontogenic tumors composed of a mixture of dental tissues. They are very common hamartomas of the jaws. However, their peripheral or gingival counterparts are extremely uncommon. The objective of this article is to report a rare case of gingival complex odontoma in an 11-year-old patient, and also to review all published cases of this type of lesion.

Cementoblastoma: oito novos casos, revisão da literatura e considerações sobre melhor manejo clínico / Cementoblastoma: report of eight cases, literature review and considerations of best approach

Cementoblastoma é um tumor odontogênico benigno incomum de origem mesenquimalque usualmente afeta ossos gnáticos de indivíduos jovens, produzindo dor ou desconforto. Pode ser erroneamente diagnosticado como outras lesões, devido sua variada apresentação clínica era diográfica. Frequentemente o tratamento sugerido é a ressecção tumoral em conjunto como dente associado. Entretanto, abordagem mais conservadora pode ser uma opção em alguns casos assintomáticos e estáveis, como observado neste estudo. Apresentamos oito novos casos e uma breve revisão da literatura a fim de melhor caracterizar o comportamento biológico desta relativamente rara lesão.

Cementoblastoma is an uncommon benign odontogenic tumour of mesenchymal originthat affects the jaws of generally young persons, producing pain or discomfort. It may be mistakenfor several other lesions, due to its varied clinical and radiographic features. The suggestedtreatment is often tumour resection in conjunction with the associated tooth. However, a moreconservative approach could be an option in asymptomatic and stable lesions as seen in thepresent study. Eight new cases and a brief review of the literature are presented here to bettercharacterize the biological behavior of this relatively rare lesion.

Estudo epidemiológico, clínico e imaginológico das lesões ósseas dos maxilares / Epidemiological, clinical and imaginologic study of bone lesions of the jaws

Introdução. O cirurgião-dentista é na maioria das vezes, o responsável pelo diagnóstico e tratamento das lesões ósseas dos maxilares. O diagnóstico é decisivo na conduta terapêutica a ser seguida. Na literatura, análises retrospectivas são vistas com maior frequência, onde foram coletados resultados de exames histopatológicos. Contudo, para algumas lesões, o diagnóstico é clínico e radiográfico, não sendo indicada a realização de biópsia. Objetivo. O objetivo deste estudo foi descrever a prevalência das lesões ósseas dos maxilares, assim como avaliar suas características clínicas e radiográficas. Correlacionar a principal hipótese diagnóstica com o diagnóstico final. Pacientes e Métodos. Estudo com 130 pacientes com lesões ósseas dos maxilares diagnosticadas no Centro de Diagnóstico Oral da Disciplina de Estomatologia Clínica da Faculdade de Odontologia da Universidade de São Paulo (CDO-FOUSP), entre Agosto de 2013 e Outubro de 2014. Os pacientes foram divididos em 4 grupos: 1: Tumores benignos odontogênicos e não odontogênicos. 2: Cistos odontogênicos e não odontogênicos. 3: Tumores malignos. 4: Outras lesões. Análise estatística foi realizada buscando estabelecer informações relevantes quanto aos dados epidemiológicos, clínicos e radiográficos destas lesões. Resultados. A idade média foi de 35,2 anos ±17,86, (variou entre 8 e 77 anos). Dos 130 pacientes, 71 eram mulheres (54,62%) e 87 leucodermas (66,92%). A mandíbula foi mais acometida (71,43%), do que a maxila (28,57%). As características clínicas mais observadas foram: aumento de volume em 60 casos (42,85%), dor em 38 (27,14%) e 16 casos (11,43%) apresentaram drenagem de secreção purulenta. O exame complementar de imagem mais utilizado foi a radiografia panorâmica, 124 exames (88,57%).

Em 47 lesões (33,57%), o diagnóstico foi realizado através do exame clínico, radiográfico e conduta cirúrgica (displasias ósseas, cistos ósseos simples, escleroses ósseas, dentre outras). Lesões com imagens radiolúcidas representaram 89 casos (63,57%), a forma unilocular esteve presente em 114 casos (81,43%) e 101 lesões (72,14%) apresentaram relação com o ápice dental. Dos casos que houve análise histopatológica (93 casos), o cisto periapical foi a lesão mais frequente totalizando 38 casos, 12 cistos dentígeros, 9 odontomas (7 compostos e 2 complexos), 8 TOQ, 6 cistos residuais, 5 ameloblastomas, e outras lesões. Houve 3 casos de tumores malignos, sendo 1 osteossarcoma, 1 carcinoma mucoepidermóide e 1 mieloma múltiplo. O percentual de acerto entre a principal hipótese diagnóstica com o diagnóstico final foi de 76,82%. Conclusões. Lesões ósseas foram frequentes e representaram aproximadamente 30% das primeiras consultas. Lesões com características radiográficas radiolúcidas e uniloculares foram as mais frequentes. Em um terço dos casos, não foi indicado (necessário) o exame histopatológico para a conclusão do diagnóstico. Sendo utilizadas as informações clínicas, radiográficas e abordagem cirúrgica (casos de cisto ósseo simples).

Introduction. The dentist is the main professional responsible for the diagnosis and treatment of bone lesions of the jaws. The diagnosis is crucial to therapeutic decision. In the literature, retrospective analyzes are more frequents, and the data are collected from histopathological exams. However, for some lesions, the diagnosis is clinical and radiographic, and the biopsy is not indicated. Objective. The aim of this study was to describe the prevalence of bone lesions of the jaws, and evaluate its clinical and radiographic features. In addition, the correlation between the main diagnosis and the final diagnosis was performed. Patients and Methods. A study which evaluated a total of 130 patients with bone lesions of the jaws. All cases were diagnosed in Oral Diagnosis Center of the Stomatology Discipline, School of Dentistry, University of São Paulo (CDO-FOUSP), between August 2013 and October 2014. Patients were divided into 4 groups: 1: Benign odontogenic and non odontogenic tumors. 2: Odontogenic and non odontogenic cysts. 3: Malignant tumors. 4: Other lesions. Statistical analysis was performed to establish relevant information on the epidemiological, clinical and radiographic data of these lesions. Results. The mean age of the patients was 35,2 years ± 17.86 (range, 8 to 77 years). Among 130 patients, 71 were women (54.62%) and 87 were Caucasians (66.92%).

The mandible was more affected (71.43%) than the maxilla (28.57%). The most frequent clinical signs were swelling in 60 cases (42.85%), pain in 38 (27.14%) and 16 cases (11.43%) showed purulent drainage. The panoramic radiograph was the most used imaging exam, 124 exams (88.57%). In 47 lesions (33.57%), the diagnosis was done by clinical examination, radiographic and surgical management (bone dysplasia, simple bone cysts, bone sclerosis, and others). Radiolucent lesions accounted for 89 cases (63.57%), the unilocular form was present in 114 cases (81.43%) and 101 lesions (72.14%) were related to the dental apex. A total of 93 cases had histopathological analyses; periapical cyst was the most frequent lesion, representing 38 cases, 12 dentigerous cysts, 9 odontomas (7 compounds and 2 complexes), 8 OKT, 6 residual cysts, 5 ameloblastomas and other lesions. There were 3 malignant tumors, 1 osteosarcoma, 1 mucoepidermoid carcinoma and 1 multiple myeloma. The correlation between the main diagnosis hypotheses with a final diagnosis showed a success rate of 76.82%. Conclusions. Bone lesions were frequent and represented approximately 30% of the first visit patients. Lesions that presented radiolucent and unilocular radiograph pattern were the most frequent. In one third of cases, it was not indicated (necessary) the histopathological examination to conclude the diagnosis. Being used data of clinical, radiographic and surgical approach (cases of simple bone cyst).

Avaliação da expressão imuno-histoquímica das proteínas p53 e pRB em ameloblastomas e tumores odontogênicos queratocísticos / Evaluation of immunohistochemistry expression of the proteins p53 and pRB in ameloblastomas and keratocystic odontogenic tumorP

Tumores odontogênicos constituem grupo abrangente de afecções tumorais, sendo ameloblastomas e tumores odontogênicos queratocísticos as lesões benignas de maior frequência, cujas características biológicas são pouco conhecidas. Objetivo do presente estudo foi avaliar o perfil imuno-histoquímico das proteínas pRB e p53 em ameloblastoma e tumor odontogênico queratocístico. Foram avaliadas amostras de material parafinado de 21 casos de ameloblastoma e de 20 casos de tumor odontogênico queratocístico para ensaio de imuno-histoquímica com os anticorpos anti-pRB e anti-p53. A contagem da imuno-marcação foi realizada a partir de fotografias de alta resolução processadas no software ImageJ para quantificação manual em campo de 1000 células. A localização da imuno-marcação para ambos anticorpos foi semelhante, sendo em ameloblastomas predominantemente nas células da periferia e, em tumores odontogênicos queratocísticos, nas camadas suprabasais. Quantitativamente, as porcentagens de células marcadas foram estatisticamente maior nos ameloblastoma para anti-p53 (p=0,01) e maior nos tumores odontogênicos queratocísticos para anti-pRB (p=0,04). Não houve correlação estatística entre a porcentagem de células marcadas para anti-p53 e anti-pRB nos ameloblastomas, porém, esta correlação foi positiva e moderada nos tumores odontogênicos queratocísticos (r=0,537; p=0,018). Nota-se ligeira diferença na quantificação das imuno-marcações para o anti-p53 e anti-pRB. Tais resultados devem ser ponderados pela reduzida casuística, porém, sugerem perfis distintos em mecanismos biológicos determinantes para ambos os tumores.

Odontogenic tumors are a comprehensive group of tumor diseases, being ameloblastomas and keratocystic odontogenic tumors the most frequent benign odontogenic tumors. Their biological characteristics are little unknown. The aim of present study was to evaluate the immunohistochemical profile of pRB and p53 proteins in 21 cases of ameloblastomas and 20 cases of keratocystic odontogenic tumors for anti-pRB and anti-p53 antibodies. The quantification of immunostaining was performed manually with high-resolution photographs processed in the ImageJ software to quantify positive cells in a 1000 cells-field. The location of immunostaining for both antibodies was similar. In ameloblastomas, positive cells are located mainly in the peripheral layers, whereas in keratocystic odontogenic tumors the positive cells are located in the suprabasal layers. Quantitatively, the percentage of labeled cells was statistically higher in ameloblastomas for anti-p53 (p = 0.01) and higher in keratocystic odontogenic tumors for anti-pRB (p = 0.04). There was no statistical correlation between the percentage of labeled cells to anti-p53 and anti-pRB in ameloblastomas, however, its correlation was positive and moderate in keratocystic odontogenic tumors (r = 0.537; p = 0.018). It is possible to identify a slight difference in immuno-quantification for anti-p53 and anti-pRB among these lesions. These results must be pondered by the small sample, however, is suggests a different profile in a preponderant key biological mechanisms for odontogenic tumors.

Estudo clinicopatológico retrospectivo dos casos de tumores odontogênicos diagnosticados no Serviço de Patologia Cirúrgica da FOUSP no período de 1957 a 2012 / Retrospective clinicopathological study of cases of odontogenic tumors diagnosed in the FOUSP Surgical Pathology Service in 1957 and 2012

Os tumores odontogênicos formam um grupo complexo de lesões, de comportamento clínico variado e encontrado exclusivamente na região bucomaxilofacial. Originam-se a partir das células que normalmente teriam a função de formar o dente, processo esse denominado odontogênese, que tem seu início entre a sexta e a sétima semanas de vida intrauterina. O objetivo deste trabalho foi realizar um estudo clinicopatológico de tumores odontogênicos diagnosticados no Serviço de Patologia Cirúrgica da Faculdade de Oodontologia da Universidade de São Paulo de 1957 a 2012. Foram compilados das fichas de requisição de exames e/ou prontuários dados referentes ao sexo, idade no momento do diagnóstico, cor da pele (branca, negra, ou outras), sintomatologia, tamanho da lesão, duração, localização anatômica, aspectos radiográficos, diagnóstico clínico e histopatológico. Os casos diagnosticados como tumores odontogênicos foram revisados, por um examinador previamente calibrado, com o objetivo de reclassificação das lesões conforme proposição atual da Organização Mundial da Saúde em 2005. Todos os dados obtidos foram inseridos e tabulados no Microsoft Office Excel 2013 e analisados no software BioEstat 5.0. Medidas de frequência central e de dispersão foram obtidas e os resultados apresentados em forma de tabelas e gráficos. Na análise estatística, foi empregado o teste Z de duas proporções com nível de significância de 5%. No período compreendido de 01 de janeiro de 1957 a 31 de dezembro de 2012, foram diagnosticados 2.114 casos de tumores odontogênicos.

Do total de casos diagnosticados, 75 casos foram retirados da análise, pois representavam a mesma lesão em diferentes momentos. Portanto, 2.039 casos de tumores odontogênicos foram incluídos e, após revisão dos casos e reclassificação diagnóstica dos tumores odontogênicos, os 2.039 casos foram agrupados em 16 tipos histológicos diferentes, entre os quais 2.029 (99,51%) eram benignos e 10 (0,49%) malignos. De uma maneira geral, os tumores odontogênicos afetam pacientes na segunda e terceira décadas de vida, sem predileção por sexo, apresentam-se menores do que 1cm de diâmetro e são diagnosticados, em média, 2 anos após seu surgimento. A maioria das lesões acometem a região posterior da mandíbula, com exceção do odontoma e tumor odontogênico adenomatóide, e apresentam aspecto radiográfico radiolúcido inespecífico, o que dificulta um diagnóstico preciso sem a avaliação anatomopatológica.

Odontogenic tumors are a complex group of lesions, varied clinical behavior and found exclusively in the oral and maxillofacial region. Originate from cells that would normally have the function of forming the tooth, a process called odontogenesis, which begins between the sixth and seventh weeks of intrauterine life. The aim of this study was a clinicopathological study of odontogenic tumors diagnosed in Surgical Pathology Service of Oodontologia of the University of São Paulo from 1957 to 2012 were compiled from surveys of request forms and / or records data on gender, age at diagnosis, skin color (white, black, or other), symptoms, lesion size, duration, anatomic location, radiographic findings, clinical and histopathological diagnosis. The cases diagnosed as odontogenic tumors were reviewed by a calibrated examiner, in order to reclassify injuries as current proposition of the World Health Organization in 2005. All data were entered and tabulated in Microsoft Office Excel 2013 and analyzed in software BioEstat 5.0. Central frequency and dispersion measurements were obtained and the results presented in tables and graphs. In the statistical analysis, we used the Z test for similar proportions with 5% significance level. In the period of January 1, 1957 to December 31, 2012 were diagnosed 2,114 cases of odontogenic tumors. Of all diagnosed cases, 75 cases

were removed from the analysis because they represented the same injury at different times. Therefore, 2,039 odontogenic tumors were included and, after review of the cases and diagnostic reclassification of odontogenic tumors, 2,039 cases were grouped into 16 different histological types, including 2 029 (99.51%) were benign and 10 (0, 49%) malignant. In general, the odontogenic tumors affect patients in the second and third decades of life, with no gender preference, are presented less than 1cm in diameter and are diagnosed on average two years after its inception. Most injuries involve the posterior mandible, except for the odontoma and adenomatoid odontogenic tumor, and feature radiolucent radiological findings nonspecific, which hinders accurate diagnosis without pathological assessment.

Peripheral Ameloblastoma with Dystrophic Calcification: An Unusual Feature in Non-Calcifying Odontogenic Tumors

Peripheral ameloblastoma is a rare extraosseous counterpart of central ameloblastoma that occurs in soft tissues and may cause bone crest resorption. This study reports a peripheral ameloblastoma on the buccal gingiva of a 56-year-old man, which presented extensive squamous metaplasia areas, keratinization and dystrophic calcifications in the neoplastic islands. It is emphasized the need of a detailed imaging study and a long follow-up period to exclude bone involvement whenever peripheral ameloblastoma diagnosis is considered.

Ameloblastoma periférico é a contraparte rara extraóssea do ameloblastoma central, que ocorre em tecidos moles e pode causar reabsorção da crista óssea. Este estudo reporta um ameloblastoma periférico localizado na gengiva vestibular de um homem de 56 anos de idade, que apresentava extensas áreas de metaplasia escamosa, queratinização e calcificação distrófica dentro das ilhas neoplásicas. É enfatizada a necessidade de um estudo de imagem detalhado e acompanhamento prolongado para excluir envolvimento ósseo sempre que o diagnóstico de ameloblastoma periférico for considerado.

A review of 156 Odontogenic Tumours in Calabar; Nigeria

Background: Odontogenic tumours occur in our environment and because of late treatment; cause considerable disabilities. Objective: To review cases of odontogenic tumours in our centre in order to obtain a baseline data and subsequently compare the results with that obtained elsewhere. Patients and methods: Using hospital case files and register; we carried out a 15-year retrospective study of odontogenic tumours at the Dental and Maxillofacial Clinic; University of Calabar Teaching Hospital; Nigeria. The data documented include age; gender; duration of lesion; type of tumour; socio-economic class; type of surgery; and complaints during follow-up reviews. Results: Majority of the patients (n=49; 31.4) were in the third decade of life. There were 85 (54.5) males and 71 (45.5) females; giving male to female ratio of 1.2:1. There was a significant association between the type of odontogenic tumour and the age of occurrence (p=0.000). The longer the duration of symptoms before presentation; the larger the tumours (p=0.000). The benign odontogenic tumours were 151 (96.8); ameloblastoma (n=74; 47.4) being the commonest. Jaw resection (54.5) was the predominant treatment. Majority (58.0) of the complications following treatment were Facial deformity; malocclusion and impaired mastication. Conclusion: Majority of the patients was in the lower socio-economic class; presented late for treatment and a few with aesthetic and functional impairment returned for secondary surgery. The intervention of agencies of government and non-governmental organizations is required to assist these patients if we are to accomplish the core healthcare system values in our environment

Peripheral fibroma obstructing the eruption pathway.

Reactive hyperplasias comprise a group of fibrous connective tissue lesions that commonly occur in oral mucosa secondary to injury. Peripheral fibroma is also a type of reactive hyperplasia. Peripheral fibroma is a reactive hyperplastic mass that occurs on the gingiva and is derived from connective tissue of the submucosa or periodontal ligament. It may occur at any age, although it does have a predilection for young adults. Females develop these lesions more commonly than do males. Here, we are presenting a case report of a child who is 6 years old and presented to us with a swelling in the lower anterior region which was providing discomfort to the child and also was obstructing the eruption pathway of the permanent central incisor in the region. The lesion was surgically excised.

Keratocystic odontogenic tumor with impacted maxillary third molar involving the right maxillary antrum:An unusual case report.

The odontogenic keratocyst (OKC), first described by Phillipsen in 1956, has metamorphosized as a keratocystic odontogenic tumor (KCOT) as reported in WHO classification of head and neck tumors in 2005. KCOT is a benign intraosseous neoplasm of the jaw and its occurrence in maxilla is unusual and its appearance in maxillary antrum along with maxillary impacted third molar is very uncommon. This article reports a case of KCOT associated with impacted maxillary third molar in right maxillary antrum and describes its rare site of occurrence.

Maxillary ameloblastic fibroma: a case report

Ameloblastic fibroma is a relatively rare benign odontogenic tumor in which both the epithelial and ectomesenchymal components are neoplastic. An 8-year-old Caucasian boy was referred to the dentist for evaluation of failed eruption of the maxillary left first molar. The panoramic radiograph showed a well-circumscribed unilocular radiolucency involving an unerupted maxillary left first permanent molar. The lesion was enucleated and the material was sent for histopathologic examination. Microscopically, it was composed by cords and islands of odontogenic epithelium in a myxoid cell-rich stroma that closely resemble the dental papilla with histopathological diagnosis of ameloblastic fibroma. After 24 months of follow-up no recurrence was observed and the maxillary left first molar erupted spontaneously through the buccal mucosa and was aligned with a fixed orthodontic appliance. This case emphasized the importance of careful differential diagnosis of intraosseous oral lesions and reported a rarity of the lesion and its atypical location.

Fibroma ameloblástico é um tumor odontogênico benigno relativamente raro, em que ambos os componentes epiteliais e ectomesenquimais são neoplásicos. Menino de oito anos de idade, branco, foi encaminhado ao dentista para avaliar a falha na erupção do primeiro molar maxilar do lado esquerdo. A radiografia panorâmica revelou imagem radiolúcida, unilocular, bem circunscrita, envolvendo o primeiro molar permanente maxilar esquerdo incluso. A lesão foi enucleada e o material encaminhado para avaliação histopatológica. Microscopicamente, era composta de ilhas e cordões de epitélio odontogênico num estroma mixóide rico em células, que se assemelhava à papila dentária, com diagnóstico histopatológico de fibroma amelobástico. Após 24 meses de acompanhamento, nenhuma recorrência foi observada e o primeiro molar permanente maxilar irrompeu espontaneamente através da mucosa bucal e foi alinhado com aparelho ortodôntico fixo. Esse caso enfatiza a importância do cuidadoso diagnóstico diferencial das lesões orais intra-ósseas e relato de lesão rara e sua localização atípica.