Single ulcers on the tongue dorsum: differential diagnosis between paracoccidioidomycosis and squamous cell carcinoma.

BACKGROUND: Paracoccidioidomycosis (PCM) is the leading cause of death among systemic mycoses in Brazil. On the other hand, oral squamous cell carcinoma (OSCC) is the most prevalent malignant neoplasm of the mouth. Both lesions rarely affect the tongue dorsum and may share similar clinical characteristics. This study aimed to retrieve cases of single oral ulcers diagnosed as PCM or OSCC. MATERIAL AND METHODS: A cross-sectional retrospective study was conducted. All patients who had a single ulcer on dorsum of the tongue and confirmed diagnosis of PCM or OSCC were evaluated. RESULTS: A total of 9 patients (5 women and 4 men) were evaluated, 5 patients had OSCCs (mean age = 69,8 years old), and 4 patients PCM (mean age = 51 years old). Most of the lesions were infiltrated and indurated in the palpation exam. Duration ranged from 1 to 12 months (mean time of 5.2 months and 4.7 months for OSCC and PCM, respectively). OSCC was the main clinical diagnosis hypothesis. CONCLUSIONS: Although uncommon, PCM and OSCC should be considered as a diferential diagnosis hypothesis in infiltrated ulcers on the tongue dorsum. Iincisional biopsy is mandatory to confirm the diagnosis and indicate the appropriate treatment.

M2 macrophages coexist with a Th1-driven profile in periapical cysts.

AIM: To evaluate the participation of both Th1 and Th2 responses in periapical cysts by assessing the presence of M2 macrophages, as well as acute IL-1 ß, TNF-α and IL-6 cytokines. METHODOLOGY: Twenty-four cases of periapical cysts were selected. Immuno-expressions of IL-1 ß, IL-6, TNF-α and CD163 were analysed in the cystic capsules in both superficial and deeper regions. Data were analysed with paired Wilcoxon test and Spearman correlation coefficient (P ≤ 0.05). RESULTS: There was a higher expression of IL-1ß, IL-6, TNF-α and M2 macrophages in the superficial region (P < 0.001) of cystic capsules. All acute cytokines had significant positive correlations amongst them regardless of the cystic capsule region. Regarding CD163, positive correlations occurred only with TNF-α (P = 0.007; r = 0.537) and IL-6 (P = 0.018; r = 0.478) in the superficial regions of the cystic capsule. CONCLUSIONS: M2 macrophages participated actively in the inflammatory response of periapical cysts and correlated with the expression of certain acute Th1-related cytokines. This illustrates the coexistence of an acute and chronic Th2-driven immune response in these lesions. Although M2 macrophages favour the healing process, their presence is not sufficient for periapical cyst regression, once an acute active response has occurred due to an infectious stimuli.

Inflammatory follicular cysts associated to necrotic primary teeth.

BACKGROUND: Cysts are pathological cavities lined by epithelium and supported by connective tissue, containing fluid or semi-fluid substances and presenting developmental or inflammatory origins. CASE REPORT: This study aimed to evaluate a case series of inflammatory follicular cysts in children to clarify their nomenclature, diagnosis, clinical implications and treatment outcomes. Prevalence, aetio-pathogenesis, clinical, radiographic and microscopic findings, treatments and sequelae of this condition were assessed by using the records of patients treated between 2000 and 2015. Data were analysed and presented descriptively. FOLLOW-UP: This was performed periodically for 2 years to monitor lesion regression and complete eruption of impacted permanent teeth. All of the involved permanent teeth erupted naturally. Twelve cases of asymptomatic lesions with volumetric bone expansion were identified through radiographic findings or delayed tooth eruption in patients aged between 8 and 14 years. After establishing the diagnosis of inflammatory follicular cyst, necrotic primary teeth extraction was followed by decompression of the cystic lesions. CONCLUSIONS: The investigated cases were consistent with inflammatory follicular cyst diagnoses. The proposed treatment was considered to be appropriate, that was revealed by the maintenance of the permanent teeth involved during the patients follow-up.

Sclerotherapy with monoethanolamine oleate in benign oral vascular lesions.

AIM: The aim of the present study was to carry out a retrospective survey at the Stomatology Clinic of a federal university in Brazil of 411 dental charts for the assessment of vascular tumors. METHODS: After the determination of the sample, the following clinical patient information was recorded: gender, age, ethnic background, marital status, profession, place of birth, clinical diagnosis, anatomic site and tumor size. RESULTS: Among all patients treated, 4.4% had benign vascular tumors in the oral cavity. The majority of these tumors were asymptomatic, with a purplish, bluish or reddish coloration and of variable size. A clinical examination and vitropressure were essential to the diagnosis. The most affected age group was 60 to 75 years. Vascular tumors most often affected white individuals and the female gender. The most common anatomic site was the tongue, followed by the buccal mucosa. Treatment with sclerotherapy proved effective, with complete regression in 94.5% of the tumors. CONCLUSION: The majority of patients demonstrated wholehearted acceptance of the treatment and side effects following the administration of the substance were slight. Sclerotherapy is a simple, low-cost method of safe and easy execution, allowing the elimination of surgical trauma and a lesser risk of hemorrhage.