Multiple congenital granular cell epulis: case report and immunohistochemical profile with emphasis on vascularization.

Congenital granular cell epulis is a rare benign soft tissue lesion arising from the alveolar ridge in neonates. A rare case of multiple congenital granular cell epulis is reported, alongside a description of its vascular immunohistochemical profile. A female newborn presented with two exophytic pedunculated red nodules located on the alveolar ridge between the future eruption sites of the incisors and canines of the mandible and maxilla. A conservative surgical excision was performed on the second day of life. Histology revealed proliferation of round granular cells containing an abundant eosinophilic cytoplasm with basophilic nuclei, ranging from round to oval in shape. Numerous blood vessels were also seen. Immunohistochemical analysis of the granular cells revealed positivity for CD68, D2-40, Ki67, VEGF, and FGF and negativity for S100, CD34, and CD105. Immunostaining for CD34, CD105, and D2-40 confirmed the presence of a large number of blood and lymphatic vessels. Although rare, an understanding of this lesion is paramount for correct diagnosis and appropriate treatment. In the present report, the immunohistochemical profile confirmed increased vascularization, proving that these lesions are composed of not only new and preexisting blood vessels, but also lymphatic vessels.

Intraoral adult rhabdomyoma: a case report.

A case of adult rhabdomyoma is reported. The lesion is a rare benign tumor of skeletal muscle origin which occurs predominantly in the head and neck region. In the present case, the clinical diagnosis favored a benign salivary gland tumor. Histologically, the tumor was composed of large round, oval, and polygonal cells of varying size with abundant pale, eosinophilic, fine, granular cytoplasm with peripherally located nuclei. Immunohistochemically, the lesion was positive for muscle-specific actin, smooth muscle actin, desmin, S100 protein, and Masson's trichrome. Electron microscopic examination confirmed the presence of numerous myofibrils. The lesion was treated by surgical resection. The clinical, histological, immunohistochemical, and ultrastructural features are discussed in this study.

Primary leiomyosarcoma of the mandible. A case report

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The aim of this article is to describe a case of leiomyosarcoma of the mandible with immunohistochemical analysis that was useful in making the final diagnosis. A 40-year-old woman was referred to the Stomatology Clinic of São Paulo Tatuapé Hospital, , for evaluation of a lesion on the left side of the mandible. This lesion presented a fast growth in the last 6 months. Intraoral examination showed a firm, fixed, red colored mass measuring, approximately 60-mm in diameter. No lymph nodes involvement was found. The radiographic examination showed a lytic lesion showed ill-demarcated radiolucent with facial and lingual cortical bone destruction. Microscopic examination of the mandibular lesion showed a neoplasm composed by interlacing fascicles of spindle-shaped cells. Most of the cells presented a blut-ended elongated shape. A marked cellular pleomorphism was observed, represented by cells with irregular shape and abundant eosinophilic cytoplasm. Nuclei were large, hyperchromatic, either vacuoled or cigar-shape. The cytoplasm of the cells stained red with Masson’s trichrome stain. Neoplastic cells expressed vimentin, smooth-muscle actin, HHF-35 and desmin. These findings were consistent with the diagnosis of leiomyosarcoma

Incidence of periodontal diagnosis in private dental practice.

PURPOSE: To evaluate the rates of periodontal examination in private dental practices in Brazil. METHODS: 235 dentists, 117 female and 118 males (mean age 33.1 years), presenting different levels of experience (mean: 11.2 years) were audited. In each dental practice, a team of two trained auditors evaluated dental examination kits for the presence of a periodontal probe, and checked whether there was any specific diagram to record the periodontal status of the patient in the model of clinical charts. The dentists were then asked whether or not they performed periodontal probing and radiographic examination of periodontal structures in all their patients. The degree of association between variables was evaluated using Chi-square or correlation tests. RESULTS: The dentists, 117 female and 118 males, were from 22 to 62 years old (mean age, 33.1 years), and presented 0.5 to 40 years of experience (mean of 11.2 years). Of the 235 clinicians, 19.3% performed periodontal probing in all their patients, and 17.5% of them record the periodontal examination, 48.9% of the professionals occasionally performed periodontal probing while 31.8% did not perform periodontal probing at all. Specialists in prosthodontics, and dentists having more than two specialties, excluding periodontists, performed periodontal probing more frequently than other specialists.

Primary malignant melanoma of the oral cavity: a case report.

A 43-year-old white man was referred to the Special Care Dentistry Center of the School of Dentistry, University of Sao Paulo, Brazil, for the diagnosis of an extensive nodular lesion of the maxillary gingiva. The patient complained that his left maxilla had swollen over the last 4 months, with some exudation from the gingival crevice, sporadic bleeding, and slight tooth mobility, but no pain. An extra-oral examination confirmed expressive swelling of the left side of the face (Fig. 1A). Palpation disclosed bilateral enlargement of the submandibular lymph nodes. An intra-oral examination showed an extensive, reddish, nodular mass (around 11 cm in diameter) that extended from the last left maxillary molar to the right maxillary incisor, covered by a mucosa that was ulcerated in some areas (Fig. 1B,C). Palpation revealed a painless, soft, bleeding tissue that seemed to arise in the periodontal ligaments, extending to the palate and vestibular area. A small pigmented spot was found in the palatal mass. Histopathologically, the biopsy revealed a proliferation of neoplastic cells that exhibited a wide variety of shapes, including spindle, plasmacytoid, and epithelioid forms. The atypical cells showed enlarged and pleomorphic nuclei. Mitotic activity and pigmented areas were observed (Fig. 2A,B). Immunohistochemistry was used to establish the final diagnosis. The tumor cells strongly expressed S100 protein, gp100 (HMB-45), melan A, and tyrosine antibodies (Fig. 2C,D). With the diagnosis of malignant melanoma, the patient was referred to an oncologist for treatment. As computed tomography revealed that the lesion was deeply inserted into the skull surface (Fig. 1D), surgical intervention was not possible. The patient underwent radiotherapy, but died 14 months later.

Sífilis secundaria en un paciente VIH positivo / Secondary syphilis in an HIV positive patient

La incidencia de afecciones orales, antes infrecuentes en pacientes infectados por VIH, se está incrementando y es posible que se subestime. Las lesiones orales resultantes de la sífilis secundaria son raras; sin embargo, ocurren, y el odontólogo debería ser capaz de realizar un correcto diagnóstico. En algunos casos la anamnesis y los signos clínicos de las lesiones son insuficientes para permitir el diagnóstico de la enfermedad. El conocimiento de sus características histológicas y las pruebas de laboratorio relevantes, así como su aplicabilidad y limitaciones son necesarios para el correcto diagnóstico de la sífilis secundaria (AU)

Expression of cytoskeletal proteins in developing human minor salivary glands.

The presence of an epithelium at different stages of proliferation and differentiation raises interesting questions concerning the histogenesis, cell turnover and differentiation of normal salivary glands. In order to expand knowledge of these aspects, we investigated the expression of cytokeratins (CKs) 7,8,10,13,14,16,18 and 19, vimentin (VIM), and smooth muscle actin (SMA) in developing human minor salivary glands using monoclonal antibodies. Labial, buccal, palatine, and lingual salivary glands and those from the floor of the mouth were obtained from human fetuses (forensic postmortem) ranging in age from gestational weeks 10 to 29. Serial sections, 3 microm thick, were immunostained using a strepto-avidin-biotin technique. Reactivity for all antibodies was negative in the salivary gland epithelium during the developmental stages of bud formation, cord growth, and branching of cord. During canalization and cytodifferentiation, the glandular epithelial cells showed a positive reaction to some CKs and SMA. Cytokeratins 7, 8, 18, and 19 showed strong labeling in luminal duct cells that exhibited some degree of morphological differentiation. Myoepithelial cellc were recognized by antibodies to SMA. Cytoskeletal protein expression changes according to the cell type, degree of differentiation, and stage of morphological development of the glandular structure. These changes occur independently of the localization of the gland.