Chondroid Tenosynovial Giant Cell Tumor of the Temporomandibular Joint: A Rare Case Report.

Tenosynovial giant cell tumor of diffuse type (TGCT-d) or pigmented villonodular synovitis (PVNS) is a locally aggressive lesion that mostly affects the joints of long bones. Chondroid tenosynovial giant cell tumor (CTGCT) or PVNS with chondroid metaplasia is a rare distinct subset of synovial tumors that has a predilection for the TMJ. We report a rare case of CTGCT in the TMJ, initially misdiagnosed as temporomandibular disorder (TMD). A 51-year-old woman was referred to the surgeon with the chief complaint of TMJ pain for 5 years and a past history of an unsuccessful TMD treatment. Extraoral examination revealed discrete preauricular swelling and restricted mandibular range of motion. Panoramic radiograph and computerized tomography showed destruction of the mandibular fossa and condyle. Histologically, the tumor was composed by large mononuclear cells with prominent eosinophilic cytoplasm and grooved nuclei, small histiocytoid cells, osteoclast-like multinucleated cells, brown pigmentation and areas of chondroid metaplasia. Morphological and immunohistochemical characteristics lead to the final diagnosis of CTGCT. The rarity of CTGCT could be attributed to the lack of recognition of this lesion, with cases diagnosed as chondroblastomas, synovial chodromatosis and chondrosarcoma. The patient received immediate reconstruction and recurrence was found 22 months after initial intervention. TGCT-d and CTGCT of the TMJ can present similar symptoms to TMD, but clinicians must distinguish both lesions by complete examination, imaging and, when necessary, histopathologic evaluation.

Chondroid Tenosynovial Giant Cell Tumor of the Temporomandibular Joint: A Rare Case Report

Abstract Tenosynovial giant cell tumor of diffuse type (TGCT-d) or pigmented villonodular synovitis (PVNS) is a locally aggressive lesion that mostly affects the joints of long bones. Chondroid tenosynovial giant cell tumor (CTGCT) or PVNS with chondroid metaplasia is a rare distinct subset of synovial tumors that has a predilection for the TMJ. We report a rare case of CTGCT in the TMJ, initially misdiagnosed as temporomandibular disorder (TMD). A 51-year-old woman was referred to the surgeon with the chief complaint of TMJ pain for 5 years and a past history of an unsuccessful TMD treatment. Extraoral examination revealed discrete preauricular swelling and restricted mandibular range of motion. Panoramic radiograph and computerized tomography showed destruction of the mandibular fossa and condyle. Histologically, the tumor was composed by large mononuclear cells with prominent eosinophilic cytoplasm and grooved nuclei, small histiocytoid cells, osteoclast-like multinucleated cells, brown pigmentation and areas of chondroid metaplasia. Morphological and immunohistochemical characteristics lead to the final diagnosis of CTGCT. The rarity of CTGCT could be attributed to the lack of recognition of this lesion, with cases diagnosed as chondroblastomas, synovial chodromatosis and chondrosarcoma. The patient received immediate reconstruction and recurrence was found 22 months after initial intervention. TGCT-d and CTGCT of the TMJ can present similar symptoms to TMD, but clinicians must distinguish both lesions by complete examination, imaging and, when necessary, histopathologic evaluation.

Resumo Tumor de células gigantes tenossinovial do tipo difuso (TCGT-d) ou sinovite vilonodular pigmentada (SVP) é uma lesão localmente agressiva que afeta principalmente as articulações dos ossos longos. Tumor de células gigantes tenossinovial condroide (TCGTC) ou SVP com metaplasia condroide é um tipo distinto e raro de tumor sinovial que tem a predileção pela articulação temporomandibular (ATM). Nós relatamos um caso raro de TCGTC da ATM, inicialmente diagnosticado, equivocadamente, como disfunção temporomandibular (DTM). Uma mulher de 51 anos foi encaminhada ao cirurgião com a queixa principal de dor na ATM por 5 anos, e uma história de tratamento de DTM sem sucesso. O exame extrabucal revelou discreto aumento de volume preauricular e movimentação mandibular restrita. A radiografia panorâmica e a tomografia computadorizada evidenciaram destruição da fossa mandibular e côndilo. Histologicamente, o tumor era composto por células mononucleares grandes, com amplo citoplasma eosinofílico e núcleo sulcado, pequenas células histiocitoides, células multinucleadas semelhantes a osteoclastos, pigmentação acastanhada e áreas de metaplasia condroide. As características morfológicas e imuno-histoquímicas levaram ao diagnóstico final de TCGTC. A raridade desta lesão pode estar associada ao seu não reconhecimento, sendo casos diagnosticados como condroblastoma, condromatose sinovial ou condrossarcoma. A paciente recebeu reconstrução imediata e recorrência foi observada 22 meses após a intervenção inicial. TCGT-d e TCGTC da ATM podem apresentar sintomas similares à DTM, mas os clínicos devem diferenciar ambas as lesões por meio do exame clínico completo, exames de imagem e, quando necessário, avaliação histopatológica.

Efeito antimicrobiano e imunomodulador de Lactobacillus reuteri em cultura de osteoblastos e Galleria mellonella desafiados por Porphyromonas gingivalis / Antimicrobial and immunomodulatory effects of Lactobacillus reuteri on osteoblasts culture and Galleria mellonella challenged by P. gingivalis

Os tratamentos mais usados para periodontite são a raspagem e aplainamento radicular, tratamento não cirúrgico, associado ou não ao uso de antimicrobianos. No entanto, novas terapias têm sido testadas com foco na modulação da resposta do hospedeiro. Alguns micro-organismos têm efeitos benéficos na saúde dos seres humanos, pois produzem efeitos antimicrobianos e anti-inflamatórios, os chamados probióticos. O presente trabalho avaliou o efeito antimicrobiano de Lactobacillus reuteri sobre Porphyromonas gingivalis e a influência deste probiótico em sua forma viva, morta (paraprobiótico) e sobrenadante em modelo de invertebrado Galleria mellonella, infectado por P. gingivalis. Posteriormente, foi determinada a viabilidade celular, níveis de óxido nítrico e de interleucina (IL)-1ßb, IL-6, IL-17 e fator de necrose tumoral (TNF)- α, através do ensaio de ELISA em osteoblastos infectados por LPS de P. gingivalis in vitro. Os dados foram submetidos ao teste estatístico ANOVA, Kruskal-Wallis ou Log-rank (Mantel-Cox), com nível de significância de 5%.L. reuteri e seu sobrenadante possuem a mesma atividade antimicrobiana. O probiótico viável e o morto apresentaram efeitos iguais na sobrevivência de G. mellonella e L. reuteri vivo foi o único que aumentou densidade hemocitária das lagartas. O probiótico e o paraprobiótico reduziram igualmente os níveis IL-1ß, IL-6, TNF-α e IL-17, sendo que o paraprobiótico, diferentemente do lactobacilo vivo, reduziu significantemente as quantidades de IL-6 e TNF-α, com relação ao grupo controle de LPS. As maiores reduções das citocinas estudadas foram obtidas com o uso do sobrenadante. Conclui-se que os efeitos antimicrobianos e imunomoduladores de L. reuteri não dependem da viabilidade celular, o que possibilita o desenvolvimento de produtos sem a bactéria viva com efeitos semelhantes. Estudos em vertebrados e clínicos são necessários para confirmar esta hipótese.(AU)

The most used treatments for periodontitis are scaling and non-surgical root planing, associated or not to the use of antimicrobials. However, new therapies have been tested with a focus on host response modulation. Some microorganisms have beneficial effects on human health because they produce antimicrobial and antiinflammatory effects, called probiotics. The present study evaluated the antimicrobial effect of Lactobacillus reuteri on Porphyromonas gingivalis and the influence of this probiotic in its live, inactivated (paraprobiotic) form and supernatant on Galleria mellonella invertebrate model, after infection by P. gingivalis. Later, the cell viability, nitric oxide levels and interleukin (IL)-1b, IL-6, IL-17 and tumor necrosis factor (TNF)- α, by the Elisa assay, were evaluated in osteoblasts infected with P. gingivalis LPS in vitro. Data were submitted to ANOVA, Kruskal-Wallis or Log-rank (Mantel-Cox) statistical test, with a significance level of 5%. L. reuteri and its supernatant have the same antimicrobial activity. The viable and inactivated probiotic had equal effects in G. mellonella survival and L. reuteri alive was the only one that increased the hemocyte density in the invertebrate model. Probiotics and paraprobiotics also reduced levels of IL-1ß, IL-6, TNF-α and IL-17 cytokines, whereas paraprobiotic, unlike living lactobacillus, significantly reduced the amounts of IL-6 and TNF-α, compare to the LPS control group. The highest reductions of the studied cytokines were obtained with the use of the supernatant. It is concluded that the antimicrobial and immunomodulatory effects of L. reuteri do not depend on cell viability, which allows the development of products without live bacterium with similar effects. Vertebrate and clinical studies are needed to confirm this hypothesis(AU)