Secondary oral syphilis presenting as a tumor-like lesion on the lower lip.

This study presents a case of atypical manifestation of secondary syphilis. Diagnosis was initiated prompted by the patient's complaint of a lower lip lesion, present for three months, resembling a malignant neoplasm. The lesion, a 3 cm (diameter) ulcerated nodule, arising from conjunctive tissue, raised concern. However, further physical examination revealed additional clinical features, including cervical micropolyadenopathy and erythematous skin lesions, prompting a reevaluation of the diagnosis, most likely secondary syphilis. These findings led to a serological investigation, which, ultimately, confirmed the diagnosis of syphilis. The case underscores the importance of recognizing syphilis as a formidable imitator, posing challenges in establishing differential diagnoses of mucocutaneous diseases.

Secondary oral syphilis presenting as a tumor-like lesion on the lower lip

ABSTRACT This study presents a case of atypical manifestation of secondary syphilis. Diagnosis was initiated prompted by the patient's complaint of a lower lip lesion, present for three months, resembling a malignant neoplasm. The lesion, a 3 cm (diameter) ulcerated nodule, arising from conjunctive tissue, raised concern. However, further physical examination revealed additional clinical features, including cervical micropolyadenopathy and erythematous skin lesions, prompting a reevaluation of the diagnosis, most likely secondary syphilis. These findings led to a serological investigation, which, ultimately, confirmed the diagnosis of syphilis. The case underscores the importance of recognizing syphilis as a formidable imitator, posing challenges in establishing differential diagnoses of mucocutaneous diseases.

Usefulness of immunohistochemical staining in diagnosing a challenging case of oral primary syphilis.

Clinicians involved in the diagnosis of mucocutaneous diseases should be aware that syphilis is still prevalent among humans and its accurate diagnosis may require substantial clinical evaluation. Herein, we report a case of primary syphilis presenting as an isolated ulcer on the upper left labial oral mucosa. The lesion exhibited no specific features and could have been easily mishandled. An important clinical observation was the presence of a satellite-enlarged lymph node in the left submandibular area, which was highly indicative of primary syphilis. Histopathological examination of the specimen obtained by punch biopsy revealed features suggestive of syphilis and immunohistochemical staining with antitreponemal antibody confirmed its diagnosis with the detection of numerous Treponema pallidum in the specimen.

A Survey of Brazilian Patients with Oral Lichen Planus Showing No Evidence of Malignancy.

Objectives: There is conflicting evidence as to whether oral lichen planus (OLP) can undergo malignant transformation into oral squamous cell carcinoma (OSCC). This study aimed to address this issue by analyzing a sample of Brazilian patients with either OLP or OSCC. Patients and Methods. This study was conducted in São Paulo, the world's fourth-largest city by population. Two groups of patients were analyzed. The OLP group consisted of 370 patients, while the OSCC group consisted of 154 patients. The OLP patients were followed up for up to 21 years to monitor clinical benefits from the management or changes in the lesion morphology; conversely, patients with OSCC were examined only twice for diagnostic purposes and referred to a specialized center. Data concerning systemic diseases, use of medications, type of oral lesions, and health-risk behaviors were recorded for patients in both groups. Results: None of the patients with OLP developed OSCC at the lesion site. Only one female patient with erosive OLP developed OSCC in the normal, lesion-free oral mucosa. None of the OSCC patients had concomitant OLP lesions; however, a higher percentage of OSCC cases (17.5%) showed white plaques (most likely oral leukoplakia) as a precursor lesion. Conclusion: The findings strongly suggest that malignant transformation of OLP is virtually nonexistent in the Brazilian population.

Laser Surgery of Extensive Homogeneous Oral Leukoplakia Histologically Suggestive of Proliferative Type: A Case Report.

Oral leukoplakia (OL) has the potential for malignant transformation; unfortunately, there are no strategies to prevent this possible outcome. Surgical intervention has been reported to be effective in reducing but not eliminating the risk of malignant transformation. Meta-analyses have reported that patients who underwent excision of OL lesions had a significantly lower chance of malignant transformation than those whose lesions were not excised. The present study aimed to report a case of successful management of extensive OL using a high-power laser. The patient has been under periodic monitoring, and we aim to continue the follow-up as long as possible. Recurrence or signs of malignancy were not observed at the 2-year follow-up.

Does autoimmune thyroid disorder act as a predisposing factor in the development of oral lichen planus?

Considering previous data from our clinic, as had consistently demonstrated a significant number of OLP patients also reporting thyroid disease (Hashimoto's thyroiditis, in particular), the present study investigated the prevalence of OLP in patients with autoimmune thyroid disease, including Hashimoto's thyroiditis and Graves' disease.

An Intriguing Case of Ectopic Benign Migratory Glossitis Resembling Secondary Syphilis: A Case Report.

Oral mucosal lesions presenting as erythematous patches usually pose difficulties for a clinical diagnosis. They elicit an array of differential diagnosis that mainly includes oral candidosis, contact mucosal reaction, oral lichenoid lesion, oral psoriasiform, autoimmune disease, and, not to forget, secondary syphilis. In this present case, all those above-mentioned possibilities were ruled out, while secondary syphilis stood as the main diagnosis. As this was also later excluded by a negative serological treponemal test, the final diagnosis rested on an ectopic manifestation of benign migratory glossitis (BMG), whose diagnosis was based on the clinical aspects of the lesions, along with their spontaneous disappearance in a short period of time (a hallmark of this condition) and the presence of fissured tongue, a manifestation that occurs very often in concomitance with BMG.

Cheilitis Glandularis of Both Lips: Successful Treatment with a Combination of an Intralesional Steroid Injection and Tacrolimus Ointment.

Cheilitis glandularis (CG) is an inflammatory condition of unknown cause that predominantly affects the minor salivary glands of the lips. Although a diagnosis of CG is not difficult, its treatment is a challenge. This article highlights the clinical presentation of the disease together with a case of successful management of this disease using a combination of a steroid injection followed by a topical immunosuppressor.

Recurrent Oral Eosinophilic Ulcers of the Oral Mucosa. A Case Report.

OBJECTIVE: This article describes a case of an Oral Eosinophilic Ulcer (OEU) in an otherwise healthy 31-year-old white woman. INTRODUCTION: The importance of reporting this case was the presence of recurrent episodes with lesions appearing in different areas of the oral mucosa, a type of manifestation not commonly associated with this disease. A typical manifestation of OEU occurs as a single ulceration that goes into healing after an incisional biopsy, a procedure usually required for a proper diagnosis of the disease. In spite of trauma being suggested as the main culprit of OEU, the exact pathogenesis mechanism of this disease remains controversial. CASE REPORT: The pattern of the present case contradicts the usually common course of the disease, as the patient had experienced many recurrent episodes for almost 2.5 years, with the recurrences occurring even after biopsies performed during some of the relapses. Differential diagnosis included recurrent aphthous stomatitis, recurrent intra-oral herpes, autoimmune disease, Crohn's disease and malignancy. CONCLUSION: Fortunately, the patient has been free of any recurrences for 1.5 years since the last biopsy was taken at the time she came to our clinic seeking treatment.

Factors affecting Clinical Outcomes after Treatment of Oral Leukoplakia with CO2 and Diode Laser.

INTRODUCTION: To analyze factors that may affect recurrence, development of new lesions, and malignant transformation in patients with oral leukoplakia (OL) following surgical treatment with lasers. MATERIALS AND METHODS: A total of 40 patients were enrolled in this study, 17 females (mean age of 64.5 years; 33-88 years) and 23 males (mean age of 56.6 years; 28-84 years) with an overall mean age of 60.5 years. A total of 49 lesions were diagnosed and treated; 9 patients had more than one site affected. Mean time of follow-up was 22 months (6-71 months). Data were assessed by univariate Cox and multivariate Cox regression analyses. RESULTS: Recurrence (OL at the same site of the initial lesion) was observed in 11 patients (27.5%) while 4 patients (10%) developed new lesions, and 2 patients (5%) experienced malignant transformation. Only two clinical factors were statistically associated with the outcome for the development of new lesions: patients ≥ 60 years and female gender (p < 0.1). Neither of the outcomes of recurrences and malignant transformations was significantly correlated with any of the risk factors analyzed. CONCLUSION: Surgical laser is not a deterrent for the outcomes evaluated; additionally, the design of this study did not allow us to determine whether the laser treatment had provided a great benefit by significantly reducing the rate of malignant transformation among the patients. CLINICAL SIGNIFICANCE: It is highly important to inform patients with OL that their condition can be treated, when possible, by surgical laser, and that this treatment may be helpful in bringing down the odds of malignant transformation of their lesions. In addition, the patients should also be brought to the attention of the necessity of a continued clinical monitoring regardless of the outcome following a surgical intervention.

Management of an Extensive Vascular Lesion on the Lip by Photocoagulation with High-Intensity Diode Laser.

OBJECTIVE: Extensive vascular malformations (VM) pose difficulties for an effective management. INTRODUCTION: This article describes a very satisfactory result, both functional and aesthetic, following a management by the technique of photocoagulation using diode laser in an extensive VM lesion involving the lower lip and left buccal mucosa in a 25 year old male. CASE REPORT: The patient reported that the lesion had been present since birth. The whole treatment, carried out under local anesthesia, spread over 6 months since as many as 4 sessions of laser, with a 1.5-month interval in each, were required. The resting period between sessions played an important part in treatment by allowing a time for the recovery of the patient and the shrinking of the lesion. CONCLUSION: The patient had no complications during the laser sessions, and his postoperative period was uneventful. No recurrence has been seen after a 2.5-year follow-up.

Prevalence of Candida spp. in Healthy Oral Mucosa Surfaces with Higher Incidence of Chronic Hyperplastic Candidosis.

INTRODUCTION: Predisposing factors in chronic hyperplastic candidosis (CHC) have been poorly recognized. This study aimed at assessing the prevalence of Candida spp. in areas of the oral mucosa showing greater prevalent rate of CHC, such as the retrocomissural area, the lateral borders of the tongue, and the hard-palate mucosa in four groups of individuals presenting predisposing factors as follows: Smoking habits (group I); patients with low salivary flow rate (SFR) (hyposalivation - group II); patients with loss of vertical dimension of occlusion (LVDO -group III); and control subjects (group IV). MATERIALS AND METHODS: A total of 44 individuals (age 4090 years, mean: 55.8 years) were divided into four groups: Group I (11 smokers); group II (10 hyposalivation patients); group III (10 LVDO patients); and group IV (control, 13 healthy subjects). All individuals were tested for Candida-pseudohyphae form by direct examination and for Candida spp. culture growth in samples obtained from the retrocomissural, tongue's lateral border, and hard-soft palatal mucosa. RESULTS: Direct examination showed a statistically significant prevalence rate for pseudohyphae (p < 0.05) on the retrocomissural and on tongue's lateral borders of individuals with LVDO. A statistically significant (p < 0.05) culture growth for Candida spp. was found on the retrocomissural areas of those with hyposalivation and with LVDO, and on the palate mucosa and on the tongue's lateral borders in the smokers and in the individuals with LVDO when compared with those of the control group. CONCLUSION: While direct examination is effective for detecting pseudohyphae, LVDO and tobacco smoking seem to be factors of relevance to the development of CHC. CLINICAL SIGNIFICANCE: Since CHC has been linked to a high rate of malignant transformation, this study analyzes some clinical (and exogenous) factors that may contribute to the development of CHC and addresses some preventive measures to reduce its incidence.

Diagnosis and Intralesional Corticotherapy in Oral Ulcers Occurring as the Sole Manifestation of Langerhans Cell Histiocytosis. A Case Report.

This article reports a case of oral mucosa lesions as the sole manifestation in Langerhans cell histiocytosis (LCH). This is a very uncommon manifestation of LCH since this disease preferably affects the bones with frequent involvement of the jaws. LCH may also involve other organs, particularly the lungs, liver, lymph nodes, and skin. The highlights of this report are the differential diagnosis, immunohistochemical analysis and, mostly, the therapeutic approach.

Successful Management of Lip and Oral Venous Varices by Photocoagulation with Nd:YAG Laser.

AIM: This study assessed the effectiveness of photocoagulation with Nd:YAG laser in the treatment of lip and oral venous varices. MATERIALS AND METHODS: Sixteen consecutive patients (eight men and eight women, mean age 56 years) diagnosed as having either lip or oral venous varices, were examined and treated with a noncontact Nd:YAG laser. As lesions were small (less than 1 cm), round or oval in shape, flat, dark to blue in color and symptomless, patients sought for treatment either for esthetic reason, bleeding or cancerophobia-related concern. RESULTS: All but one lesion were successfully treated with only one irradiation exposure. Healing was completed in about 2 to 4 weeks; none of the patients experienced complications or recurrence. Pain was out of any major concern during immediate follow-up. CONCLUSION: Although photocoagulation with Nd:YAG laser did not outperform the effectiveness observed with diode laser (data shown in a previous study),(17) it proved to be safe and effective for the treatment of lip and oral varices, with consistent results. CLINICAL SIGNIFICANCE: Most of patients with oral and lip varices only need some clinical advice regarding the their nature of their lesions. Yet, for those who seek treatment for this conditions, the use Nd:YAG laser is an option as it yields satisfactory outcomes.

Cinnamon-induced Oral Mucosal Contact Reaction.

Contact stomatitis associated with consumption of cinnamon flavoring agents is a relatively uncommon disorder. Of relevance, both clinical features and the histopathologic findings of this condition are nonspecific, and, more importantly, may resemble some other inflammatory oral mucosa disorders, eventually making diagnosis difficult. Usually a patient exhibits a combination of white and erythematous patches of abrupt onset, accompanied by a burning sensation. To shed some light on this subject, a case of a 64-year-old woman with hypersensitivity contact reaction on the oral mucosa due to cinnamon mints is presented, with emphasis on differential diagnosis and the process for confirmation of the diagnosis. The treatment consists of discontinuing the use of cinnamon products. Clinicians will be able to recognize this disorder following a careful clinical examination and detailed history. This recognition is important in order to avoid invasive and expensive diagnostic procedures.

Refractory Pigmentation Associated with Laugier-Hunziker Syndrome following Er:YAG Laser Treatment.

The present report describes a case of Laugier-Hunziker syndrome (LHS), a rare benign condition. A patient with LHS develops acquired melanotic pigmentation of the lips and buccal mucosa, often with pigmentation of the nails occurring. No systemic symptoms are associated with this syndrome. Normally, no treatment is required for this condition, unless for aesthetic reason, mainly due to pigmentation on the lip mucosa. We present a case of LHS, 37-year-old female, whose pigmentations on her lip and in the oral cavity were treated with an Er:YAG laser. At the postoperative 12th month followup, the lesions recurred. The effects of any surgical attempt to treat pigmentations associated with LHS were discussed.