Adenocarcinoma of mammary origin in the maxillary gingiva: a case report and brief literature review.

Maxillofacial metastases are rare but represent advanced disease progression and a poor prognosis. The primary purpose of this article is to describe a patient with previously diagnosed and treated invasive ductal breast carcinoma who developed a metastatic lesion in the maxillary gingiva. In addition, this article presents a brief literature review of case reports on metastatic breast cancer manifestations in the gingiva. In the present case, a 68-year-old woman had been diagnosed and treated for invasive ductal breast carcinoma. At the 6-month follow-up after treatment for breast cancer, she complained of pain in the right leg and spine, swelling in the right arm associated with redness, and a nodular growth in the maxillary gingiva that was painful, friable, and associated with tooth mobility. Imaging examinations and microscopic analysis of an oral biopsy specimen revealed disease progression to the oral cavity, femur, lung, and brain. Because of the advanced disease, the patient died within a few weeks. The literature review identified 6 articles that reported varied clinical presentations of metastatic breast cancer in the gingiva. Invasive ductal carcinoma was the most common histologic type. Routine dental follow-up of patients with cancer is essential for the identification and diagnosis of oral lesions to ensure early intervention for lesions that may be distant metastases mimicking benign lesions.

Diagnosis and treatment of oral lichen sclerosus in a pediatric patient.

Lichen sclerosus is an uncommon chronic inflammatory disease, which rarely affects the oral mucosa. Here, we describe the occurrence of oral lichen sclerosus with gingival destruction in a 12-year-old female patient. After diagnostic confirmation by histopathology, intralesional injection of corticosteroid was performed, producing satisfactory remission of the lesion.

Peripheral giant cell granuloma associated with a dental implant.

BACKGROUND: Peripheral giant cell granuloma (PGCG) is an uncommon pathology that affects gingival or alveolar mucosa. Although PGCG can be associated with dental implants, little is known about this lesion and implant osseointegration as well as its etiopathogenesis and the treatments available. This study sought to report a rare case of PGCG associated with dental implant, emphasizing its clinical and histopathological aspects. CASE PRESENTATION: A 53-year-old man had an exophytic, reddish lesion, around a crown attached to a dental implant located in the left mandible. Radiographically, there was bone loss around the implant. After excisional biopsy, histological examination revealed a submucosal proliferation of multinucleated giant cells rendering the diagnosis of peripheral giant cell granuloma. Patient has been under follow-up for 6 months with no recurrence. CONCLUSIONS: Peri-implant lesions must be completely removed to prevent recurrence of PGCG and implant failure, even in cases suspected to be reactive. Besides, histological examination must be performed on all peri-implant reactions to achieve the appropriate diagnosis and, consequently, the best treatment and follow up.

Florid osseous dysplasia associated with multiple simple bone cysts: a patient with 22 years of follow-up.

Florid osseous dysplasia (FOD) has been described as a condition that typically affects the jaws of middle-aged women of African descent and usually presents as multiple radiopaque masses distributed throughout the jaws. The diagnosis is generally based on clinical and radiographic presentation, often involving various regions of the jaws without evident bone expansion. This article describes the course of FOD in a 27-year-old African-American woman during 22 years of follow-up, emphasizing the dynamic radiographic characteristics of this entity and unusual co-occurrence with multiple simple bone cysts. These data reinforce the importance of long-term follow-up in patients diagnosed with FOD.

Epithelial-myoepithelial carcinoma of the minor salivary glands: a case report and review of the literature.

Epithelial-myoepithelial carcinoma (EMC) is a rare tumor, especially in the minor salivary glands. This case report describes a 40-year-old man who presented with an EMC on the palate. Histologically, the tumor was characterized by a biphasic structure consisting of duct-lining cuboidal cells in the inner layer and clear myoepithelial cells in the outer layer. The clear cells predominated, and the diagnosis was confirmed with immunohistochemical staining. The inner cuboidal epithelial cells were positive for cytokeratins, whereas the outer cells were positive for S-100 protein and smooth muscle actin. The patient was treated with a wide surgical excision, and no recurrence or metastasis was observed at a 10-year follow-up. A literature review found only 30 well-documented cases of EMC in the intraoral minor salivary glands.

Clinical and laboratorial profile and histological features on minor salivary glands from patients under investigation for Sjögren's syndrome.

UNLABELLED: Diagnosis of Sjögren's syndrome (SS) is complex and the usefulness of labial minor salivary glands biopsy in this process remains controversial. OBJECTIVE: to evaluate the clinical and laboratorial profile and histological features on labial minor salivary glands from patients under investigation of SS. STUDY DESIGN: clinical charts from 38 patients under suspicion of SS and submitted to labial minor salivary glands biopsies were reviewed. Clinical and laboratorial data were retrieved from the clinical files and the HE-stained histological slides were reviewed under light microscopy. RESULTS: mean age of the patients was 56.5 years and 97% were females; histological analysis showed that 42% of the cases showed ductal dilatation, lymphocytic foci were found in 52.6% and, from this group, 80% of the cases presented a foci/lobules ratio above 0.8. Acinar/ductal ratio was considered diminished in 39.5% of the samples. Thirty six (95%) and 32 (84%) patients, respectively, complained about xerostomia and xerophthalmia. A study of the time interval of the symptoms that led to SS investigation showed a mean of 116 months. Moreover, sixty-six percent of the patients had already been submitted to immunosuppressive therapy prior to the labial minor salivary gland biopsy. Age of the patients, scintigraphic alterations on salivary function, antinuclear factor (ANF), anti-Ro and anti-La did not show statistical significant association with the histological features. Lobules/foci ratio above 0.8 was the only histological parameter statistically associated with Sjögren's syndrome diagnosis (p<0.0001). CONCLUSIONS: in the studied sample, lymphocytic foci on salivary glands were the only histological parameter associated to the diagnosis of SS. Early indication of labial minor salivary gland biopsy to patients under investigation of SS could limit the effects of immunosuppressive therapy on the histological features associated with the evolution of salivary gland involvement in SS.

Oral and oropharyngeal diffuse large B-cell lymphoma and high-grade B-cell lymphoma: A clinicopathologic and prognostic study of 69 cases.

OBJECTIVE: The objective of this study was to describe the clinicopathological, molecular, and prognostic features of oral/oropharyngeal diffuse large B-cell lymphoma (DLBCL) and high-grade B-cell lymphoma. STUDY DESIGN: All cases were retrieved from 7 Brazilian institutions. Immunohistochemical reactions were performed to confirm the diagnoses and to categorize the tumors. In situ hybridization was used to detect Epstein-Barr virus (EBV) and fluorescence in situ hybridization was used to identify gene rearrangements. RESULTS: Most cases involved the oral cavity (76.8%). Males and females, with a mean age of 60 years, were evenly affected. Tumors mostly presented as painful swellings. Forty cases represented germinal center B-cell type (58%). Five cases presented double-hit translocation and 3 harbored rearrangement for MYC/BCL2/BCL6. EBV was detected in 3 cases (4.3%). The 5-year overall survival was 44.4%. Female sex, presence of pain and ulcer, microscopic "starry sky pattern" and necrosis, co-expression of c-Myc/Bcl2, and translocation of MYC were associated with a lower survival in univariate analysis (P = .05, P = .01, P = .01, P = .03, P = .05, P = .006, P = .05, respectively). CONCLUSION: Patients affected by oral/oropharyngeal DLBCL have a low survival rate. High-grade B-cell lymphoma (17.7%) and EBV-positive DLBCL, not otherwise specified (4.3%) account for a small number of cases.

Evaluation of KGF, EGF, VEGF, bcl-2, IL-6 and ki67 expression in oral epithelium adjacent to bisphosphonate-related osteonecrosis and florid osseous dysplasia: a comparative immunohistochemical study.

OBJECTIVE: The aim of this study was to compare the expression of proliferative markers and apoptosis-associated proteins in the oral mucosa adjacent to bone sequestrum associated with osteonecrosis (ON) of the jaws and florid osseous dysplasia (OD). STUDY DESIGN: Oral mucosal samples derived from surgical procedures performed for treatment of ON and OD (10 cases each) were retrieved. Histologic analysis was done on hematoxylin and eosin-stained slides; immunohistochemical reactions against epidermal growth factor (EGF), keratinocyte growth factor (KGF), vascular endothelial growth factor (VEGF), Bcl-2 protein, interleukin-6 (IL-6), and Ki-67 antigen were performed with the immunoperoxidase technique. RESULTS: The epithelium was hyperplastic in 60% and 22% of ON and OD samples, respectively. Cytoplasmic EGF and KGF expression; Bcl-2, VEGF, and IL-6 expressions; and the mean epithelial proliferative index were not statistically different between the 2 groups. Membranous EGF expression was more evident in samples showing hyperplastic epithelium. CONCLUSIONS: Exposure to bisphosphonates did not alter the expression of KGF, EGF, VEGF, Bcl-2, IL-6, and the epithelial proliferating index in comparison with inflamed oral mucosa not exposed to bisphosphonates.

Avaliação Radiográfica da Maxila e da Mandíbula de Pacientes Diagnosticados com Mieloma Múltiplo: Estudo Retrospectivo / Radiographic Evaluation of the Maxilla and Mandible of Patients Diagnosed with Multiple Myeloma: Retrospective Study Evaluación / Radiográfica del Maxilar y de la Mandíbula de Pacientes Diagnosticados de Mieloma Múltiple: Estudio Retrospectivo

Introdução: O mieloma múltiplo é caracterizado como uma neoplasia maligna plasmocitária com a proliferação anormal de plasmócitos clonais na medula óssea de etiologia desconhecida. Objetivo: Caracterizar os pacientes com mieloma múltiplo atendidos no Setor de Estômato-Odontologia e Prótese do INCA, por meio de dados sociodemográficos, clínicos, laboratoriais e radiográficos. Método: Estudo transversal retrospectivo de pacientes com diagnóstico de mieloma múltiplo, no período de 2000 a 2018, que realizaram radiografia panorâmica no período do diagnóstico da doença. Os dados sociodemográficos e clínico-radiográficos da população em estudo foram coletados nos prontuários dos pacientes, armazenados em banco de dados, analisados de forma descritiva e submetidos ao teste não paramétrico X2 (qui-quadrado). Resultados: Na amostra final, foram totalizados 163 casos. A maioria era de homens (56,4%), brancos (55,8%), com idade ≤55 anos (54%), ensino fundamental incompleto (30,7%), não fumantes (54,6%) e não bebedores (54,6%). Havia lesões líticas em 46 pacientes (28,2%) com predileção pela mandíbula (82,6%; p=0,000). Houve maior frequência de margens parcialmente definidas (50,0%), não escleróticas (78,2%) e de aspecto unilocular (43,5%). Dos 46 pacientes que apresentaram lesão lítica maxilomandibular, 27 pacientes tinham >55 anos (p=0,042). Conclusão: Há maior ocorrência de lesões ósseas na mandíbula quando comparada à maxila

Introduction: Multiple myeloma is defined as a plasma cells malignant neoplasm with abnormal proliferation of clonal plasma cells in the bone marrow of unknown etiology. Objective: To characterize patients with multiple myeloma treated at INCA's Department of Stomato-Dentistry and Prosthodontics, utilizing sociodemographic, clinical, laboratory and radiographic data. Method: Retrospective cross-sectional study of patients diagnosed with multiple myeloma from 2000 to 2018 who underwent panoramic radiography at the diagnosis of the disease. The sociodemographic and clinical-radiographic data of the study population were collected from the patients' medical records stored in a database, analyzed descriptively and submitted to the X2 non-parametric test (chisquare). Results: In the final sample, 163 cases were totaled, mostly men (56.4%), white (55.8%), aged ≤55 years (54%), with incomplete elementary education (30.7%), non-smokers (54.6%), and non-alcoholics (54.6%). There were lytic lesions in 46 patients (28.2%) concentrated in the mandible (82.6%; p=0.000). Higher frequency of partially defined margins (50.0%), non-sclerotic (78.2%) and unilocular aspect (43.5%) were found. Of the 46 patients who presented with a maxillomandibular lytic lesion, 27 were older than 55 years (p=0.042). Conclusion: There was higher occurrence of bone lesions in the mandible when compared to the maxila

Introducción: El mýeloma multiple se caracteriza por ser una neoplasia maligna de células plasmáticas con proliferación anormal de células plasmáticas clonales en la médula ósea de etiología desconocida. Objetivo: Caracterizar a los pacientes con mýeloma multiple atendidos en el Departamento de Estomato-Odontología y Prostodoncia del INCA, utilizando datos sociodemográficos, clínicos, de laboratorio y radiográficos. Método: Estudio transversal retrospectivo de pacientes diagnosticados de mýeloma multiple de 2000 a 2018 a los que se les realizó una radiografía panorámica durante el período de diagnóstico de la enfermedad. Los datos sociodemográficos y clinicorradiográficos de la población de estudio fueron recolectados de la historia clínica de los pacientes, almacenados en una base de datos, analizados descriptivamente y sometidos a la prueba no paramétrica X2 (chi-cuadrado). Resultados: En la muestra final, había un total de 163 casos, en su mayoría hombres (56,4%), blancos (55,8%), edad ≤55 años (54%), con educación primaria incompleta (30,7%), no fumadores (54,6%) y no bebedores (54,6) %). Hubo lesiones líticas en 46 pacientes (28,2%) con predilección por la mandíbula (82,6%; p=0,000). Hubo una mayor frecuencia de márgenes parcialmente definidos (50,0%), no escleróticos (78,2%) y de apariencia unilocular (43,5%). De los 46 pacientes que tenían lesión lítica maxilomandibular, 27 pacientes tenían >55 años (p=0,042). Conclusión: Existe una mayor ocurrencia de lesiones óseas en la mandíbula en comparación con el maxilar

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.

BPI-fold (BPIF) containing/plunc protein expression in human fetal major and minor salivary glands.

The aim of this study was to determine expression, not previously described, of PLUNC (palate, lung, and nasal epithelium clone) (BPI-fold containing) proteins in major and minor salivary glands from very early fetal tissue to the end of the second trimester and thus gain further insight into the function of these proteins. Early fetal heads, and major and minor salivary glands were collected retrospectively and glands were classified according to morphodifferentiation stage. Expression of BPI-fold containing proteins was localized through immunohistochemistry. BPIFA2, the major BPI-fold containing protein in adult salivary glands, was detected only in the laryngeal pharynx; the lack of staining in salivary glands suggested salivary expression is either very late in development or is only in adult tissues. Early expression of BPIFA1 was seen in the trachea and nasal cavity with salivary gland expression only seen in late morphodifferentiation stages. BPIFB1 was seen in early neural tissue and at later stages in submandibular and sublingual glands. BPIFA1 is significantly expressed in early fetal oral tissue but BPIFB1 has extremely limited expression and the major salivary BPIF protein (BPIFA2) is not produced in fetal development. Further studies, with more sensitive techniques, will confirm the expression pattern and enable a better understanding of embryonic BPIF protein function.

Oral and maxillofacial considerations in Gardner's syndrome: a report of two cases.

Gardner's syndrome (GS) is a genetic disorder characterised by intestinal polyps, multiple osteomas, and soft-tissue tumours. Dentists play an important role in the syndrome diagnosis considering that craniomaxillofacial osteomas are a major criteria for Gardner's syndrome diagnosis. This study aimed to describe the main stomatological manifestation of GS and the importance of dentists in its diagnosis. Two patients presenting GS were evaluated. The first one had two osteomas in the mandible and GS was suspected. The colonoscopy confirmed the presence of polyposis and a prophylactic proctocolectomy was performed. The other patient had a late-stage diagnosis of GS and developed a rectum adenocarcinoma. The presence of craniomaxillofacial osteomas are a hallmark of the disease. Early-stage GS diagnosis may enable early diagnosis and preventive strategies in carriers. Other dental abnormalities, such as supernumerary teeth, hypercementosis and odontomas, can also be observed.

Clinical, demographic, and radiographic analysis of 82 patients affected by florid osseous dysplasia: an international collaborative study.

OBJECTIVE: The aim of this study was to correlate the clinical, demographic, and radiographic aspects of 82 cases of florid osseous dysplasia (FOD) from four countries assessed by five reviewers. STUDY DESIGN: Retrospective data of patients diagnosed with FOD were obtained from archives of five institutes and analyzed according to clinical and radiographic criteria. RESULTS: A total of 82 cases of FOD were included in the study. In the majority (77.5%) of FOD cases, black women were affected. The disease mainly affected the mandible (100%), and the stage of the lesion was directly correlated with the age (P < .05). The rates of convergence showed confluence of assessment in the mandible (posterior), and the highest rate of divergence between the reviewers was in assessing involvement in the maxilla. There were no differences among the characteristics of the lesion provided by the five institutions, except for the variable proportion of black patients affected by the disease. CONCLUSIONS: FOD mostly affects the mandible of middle-aged black women, and its stage is correlated with patient age. Although panoramic radiography is used for diagnosis, the divergence in assessment of the maxilla might indicate that this method is not the most suitable to evaluate this area.

Autophagy interplays with apoptosis and cell cycle regulation in the growth inhibiting effect of Trisenox in HEP-2, a laryngeal squamous cancer.

Laryngeal squamous cell carcinoma (LSCC) is the most common among several types of head and neck cancers. Current treatments have a poor effect on early and advanced cases, and further investigations for novel agents against LSCCs are desirable. In this study, we elucidate the cytotoxic enhancing effect of arsenic trioxide (As2O3) combined with L-buthionine sulfoximine (BSO) in LSCC. The effect of BSO with As2O3 or Cisplatin (CDDP) on cell viability was examined using 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT). The reactive oxygen species (ROS) levels, cell cycle, and apoptosis were measured by flow cytometry using 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA), propidium iodide (PI) and annexin V/PI. The acidic vacuolar organelles were visualized by fluorescence microscope and quantified using flow cytometry. Neither CDDP nor As2O3 when used alone reduced the cell viability. BSO was found to enhance only As2O3 sensitivity, leading to G2/M arrest and autophagy with no correlation of ROS induction. This result suggests that modulation of glutathione enhances autophagy, which interplays with apoptosis. In this study, we obtained initial preclinical evidence for the potential efficacy of these drugs in a combined therapy protocol.

Intraosseous Non-Hodgkin Lymphoma Mimicking a Periapical Lesion.

Non-Hodgkin lymphomas are a group of disorders involving malignant monoclonal proliferation of lymphoid cells, which appear at extranodal sites in approximately 40% of the cases, particularly in the gastrointestinal tract. Intraosseous lymphomas of the head and neck region are extremely rare and can mimic other diseases such as periodontitis or periapical pathologies. This report presents an additional case of intraosseous lymphoma that was previously misdiagnosed as periapical disease. In addition, a literature review was made based on PubMed, and all cases of periapical lymphoma were analyzed. After the diagnosis of lymphoma, the current patient was treated with 6 cycles of chemotherapy and showed satisfactory outcome. The literature review displayed 29 cases of lymphoma affecting the periapical region, and in 51.7% of them endodontic treatment was performed previously to the diagnosis of lymphoma. Although lymphoma is uncommon in the oral cavity, some symptoms can assist the dentist to suspect malignant conditions, mainly in cases presenting numb chin syndrome.

Abordagem Cirúrgica de Osteorradionecrose Mandibular Causada por Fratura Idiopática / Surgical Approach of Mandible Osteoradionecrosis Caused by Idiopathic Fracture / Abordaje Quirúrgico de Osteorradionecrosis Mandibular Causada por Fractura Idiopática

Introdução: A osteorradionecrose acomete de 1% a 6% dos pacientes submetidos à radioterapia e é considerada a complicação oral mais grave advinda dessa modalidade terapêutica. Relato do caso: Trata-se de um homem, 65 anos, com diagnóstico de carcinoma de células escamosas em assoalho bucal esquerdo, tratado com cirurgia e radioterapia adjuvante. Na avaliação odontológica inicial, não foram observadas alterações clínicas ou radiográficas. Duas semanas após o término da radioterapia, o paciente relatou ter acordado com dor intensa em mandíbula, sem relato de trauma ou queda. A radiografia panorâmica evidenciou fratura no corpo mandibular esquerdo, sugerindo fratura idiopática durante o sono. Após dez dias, houve exposição óssea intraoral do coto distal e preconizou-se tratamento conservador com analgesia, osteotomia superficial sob anestesia local e antibioticoterapia profilática. O paciente evoluiu com secreção purulenta, fístula extraoral e eliminação de sequestro ósseo, após cinco meses, confirmando o diagnóstico de osteorradionecrose. Diante desse quadro, após 11 meses do diagnóstico da fratura, optou-se pela intervenção cirúrgica de mandibulectomia redutora de coto distal. Depois de sete meses de acompanhamento pós-cirúrgico, o paciente encontra-se sem evidências clínicas e radiográficas de osteorradionecrose. Conclusão: O tratamento da osteorradionecrose é considerado desafiador para os dentistas que lidam com essa sequela da radioterapia. Portanto, destaca-se a importância da capacitação do dentista para atuar em todas as etapas do tratamento oncológico

Introduction: Osteoradionecrosis of the jaws affects 1% to 6% of patients undergoing radiotherapy and is considered the most severe oral complication resulting from this therapeutic modality. Case report: This is a 65-year-old man diagnosed with squamous cell carcinoma in the left oral floor, treated with surgery and adjuvant radiotherapy. In the dental evaluation, no clinical or radiographic changes were observed. Two weeks after the radiotherapy, the patient reported severe pain in the mandible, with no report of trauma or fall. The panoramic radiograph showed a fracture in the left mandibular body, suggesting an idiopathic fracture while asleep. After ten days, there was intraoral bone exposure of the distal portion of the mandible and conservative treatment with analgesia, superficial osteotomy under local anesthesia and prophylactic antibiotic therapy was performed. The patient evolved with purulent secretion, extraoral fistula and elimination of bone sequestration, after five months, confirming the diagnosis of osteoradionecrosis. Thereby, 11 months after the fracture diagnosis, the patient underwent a surgical intervention with partial mandibulectomy of the distal portion. After seven months of post-surgical follow-up, the patient presents neither clinical or radiographic evidence of osteoradionecrosis. Conclusion: The treatment of osteoradionecrosis is considered challenging for dentists who deal with this side effect of radiotherapy. Therefore, the importance of training the dentist to work in all stages of cancer treatment is highlighted.

Introducción: La osteorradionecrosis afecta del 1% al 6% de los pacientes sometidos a radioterapia y se considera la complicación oral más grave resultante de esta modalidad terapéutica. Relato del caso: Hombre, 65 años, diagnosticado con carcinoma de células escamosas en el suelo de boca izquierdo, tratado con cirugía y radioterapia adyuvante. La evaluación odontológica no presentó alteraciones clínicas o radiográficas. Dos semanas después de concluir la radioterapia, él informó haber despertado con un fuerte dolor en la mandíbula, sin historia de trauma o caída. La radiografía panorámica mostró una fractura en el cuerpo mandibular izquierdo, lo que sugirió una fractura idiopática durante el sueño. Diez días después, hubo exposición ósea intraoral del muñón distal y fue empleado tratamiento conservador con analgesia, osteotomía superficial bajo anestesia local y antibiótico profiláctico. El paciente evolucionó con secreción purulenta, fístula extraoral y eliminación de secuestro óseo, pasados cinco meses, confirmando el diagnóstico de osteorradionecrosis. Así, pasados 11 meses del diagnóstico de fractura, fue indicada intervención quirúrgica de mandibulectomía reductora del muñón distal. Después de siete meses de la cirugía, no hay evidencias clínicas o radiográficas de osteorradionecrosis. Conclusión: El tratamiento de la osteorradionecrosis se considera un desafío para los dentistas que se ocupan de esta secuela de la radioterapia. Por lo tanto, se destaca la importancia de capacitar al dentista, para que trabaje en todas las etapas del tratamiento oncológico

BPI-fold (BPIF) containing/plunc protein expression in human fetal major and minor salivary glands

Abstract The aim of this study was to determine expression, not previously described, of PLUNC (palate, lung, and nasal epithelium clone) (BPI-fold containing) proteins in major and minor salivary glands from very early fetal tissue to the end of the second trimester and thus gain further insight into the function of these proteins. Early fetal heads, and major and minor salivary glands were collected retrospectively and glands were classified according to morphodifferentiation stage. Expression of BPI-fold containing proteins was localized through immunohistochemistry. BPIFA2, the major BPI-fold containing protein in adult salivary glands, was detected only in the laryngeal pharynx; the lack of staining in salivary glands suggested salivary expression is either very late in development or is only in adult tissues. Early expression of BPIFA1 was seen in the trachea and nasal cavity with salivary gland expression only seen in late morphodifferentiation stages. BPIFB1 was seen in early neural tissue and at later stages in submandibular and sublingual glands. BPIFA1 is significantly expressed in early fetal oral tissue but BPIFB1 has extremely limited expression and the major salivary BPIF protein (BPIFA2) is not produced in fetal development. Further studies, with more sensitive techniques, will confirm the expression pattern and enable a better understanding of embryonic BPIF protein function.

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.