An Uncommon Occurrence of Three-Fourth Molars Concomitant to Hypodontia in a Nonsyndromic Patient.

Bilaterally mandibular and maxillary fourth molars, concomitant to hypodontia, are uncommon. These dental anomalies, called hypohyperdontia, are rare and etiology is not well defined. Several complications may occur as a consequence of supernumerary teeth, such as teeth impaction, resorption of adjacent teeth, and development of cysts and tumors. The authors present an uncommon occurrence of three-fourth molars concomitant to hypodontia and dentigerous cyst associated with impacted mandibular second and third molars in a nonsyndromic patient. The authors attempt to discuss the occurrence of bilaterally fourth molars and reinforce the importance of clinical approach, considering risks and benefits for the patient.

Burkitt Lymphoma in Adult With Atypical Clinical Presentation Primarily Involving the Oral Soft Tissue.

Non-Hodgkin lymphoma is the second most common neoplasm of the head and neck after squamous cell carcinoma. However, it accounts for only 3.5% of all malignancies of the oral cavity. Oral lesions are often a component of disseminated disease process that may involve regional lymph nodes or may at times represent the primary extra nodal form of the disease. Although, isolated oral lymphoma in adults is extremely rare, this paper presents a patient with Burkitt lymphoma in an adult male with atypical clinical presentation primarily involving the oral soft tissue. It is believed that the prognosis of Burkitt lymphoma depends on the extent of the disease, the patient's age, and the timing of diagnosis. Therefore, the role of the dentist in the early diagnosis and prompt referral of patients with Burkitt lymphoma cannot be overemphasized.

Expression of E-cadherin and ß-catenin in basaloid and conventional squamous cell carcinoma of the oral cavity: are potential prognostic markers?

BACKGROUND: Basaloid squamous cell carcinoma presents with a preference for the head and neck region, and shows a distinct aggressive behavior, with frequent local recurrences, regional and distant metastasis. The alterations in the cadherin-catenin complex are fundamental requirements for the metastasis process, and this is the first study to evaluate the immunostaining of E-cadherin and ß-catenin in oral basaloid squamous cell carcinoma. METHODS: Seventeen cases of this tumor located exclusively in the mouth were compared to 26 cases of poorly differentiated squamous cell carcinoma and 28 cases of well to moderately differentiated squamous cell carcinoma matched by stage and tumor site. The immunostaining of E-cadherin and ß-catenin were evaluated in the three groups and compared to their clinicopathological features and prognosis. RESULTS: For groups poorly differentiated squamous cell carcinoma and basaloid squamous cell carcinoma, reduction or absence of E-cadherin staining was observed in more than 80.0% of carcinomas, and it was statistically significant compared to well to moderately differentiated squamous cell carcinoma (p = .019). A strong expression of ß-catenin was observed in 26.9% and 20.8% of well to moderately differentiated squamous cell carcinoma and poorly differentiated squamous cell carcinoma, respectively, and in 41.2% of basaloid squamous cell carcinoma. The 5-year and 10-year overall and disease-free survival rates demonstrated no significant differences among all three groups. CONCLUSIONS: The clinical and biological behavior of three groups of the oral cavity tumors evaluated are similar. E-cadherin and ß-catenin immunostaining showed no prognostic value for basaloid and conventional squamous cell carcinomas.

The relationship between ezrin and podoplanin expressions in keratocystic odontogenic tumors.

BACKGROUND: The aims of this study were to investigate the immunolocalization of ezrin and its relationship with the podoplanin expression in keratocystic odontogenic tumors. MATERIAL AND METHODS: The immunohistochemical expressions of ezrin and podoplanin by odontogenic epithelium were evaluated in keratocystic odontogenic tumors using monoclonal antibodies. RESULTS: Our results showed strong cytoplasmic ezrin and membranous podoplanin expressions in basal epithelial layer of all keratocystic odontogenic tumors. The cytoplasmic and membranous ezrin expressions were also detected in suprabasal epithelial layers of tumors. Statistically significant difference between cellular immunolocalization of ezrin and podoplanin odontogenic epithelium were found by Wilcoxon's test (p < 0.05). No correlation between both proteins in keratocystic odontogenic tumors was detected by Spearman test. CONCLUSIONS: These results suggest that ezrin and podoplanin may contribute to the expansive growth and local invasiveness of keratocystic odontogenic tumors. Additionally, as both proteins were overexpressed by odontogenic epithelium, their possible roles need to be further explored in benign odontogenic tumors.

Oral verruciform xanthomas mimicking potentially malignant disorders.

Verruciform xanthoma represents a reactive lesion, common in the skin and somewhat rare in the mouth. Cases description: Two cases of verrucous white plaques, located on the tongue and the floor of mouth of different 30-years-old man and woman and clinically diagnosed as leukoplakia, are described. The histopathological analyses confirmed the diagnosis of oral verruciform xanthomas for both lesions. Practical implications: Despite of uncommon in the oral cavity, the verruciform xanthoma, particularly when affecting regions with a higher risk of developing oral cancer, should be included in differential diagnosis of oral potentially malignant disorders. The histopathological analysis remains as "gold standard technique" for a more accurate diagnosis of oral verruciform xanthoma. Key words:Foam cells, Verruciform xanthoma, Leukoplakia, Tongue.

Clinical behavior of recurrent pleomorphic adenoma in the palate: a systematic review.

PURPOSE: This systematic review analyzed the clinical behavior and odds of malignancy of the palatal recurrent pleomorphic adenomas. METHODS: Systematic review of patients with recurrent pleomorphic adenoma arising in the palate. Database search: MEDLINE, Scopus, Web of Science, Cochrane, EMBASE, Virtual Health Library, Google Scholar, and OpenGrey. A binomial logistic regression was performed to assess the odds of detecting recurrence five, 10 and 20 years after the treatment of primary tumor. RESULTS: Thirteen studies (n = 18 patients) out of 336 were included. The recurrent pleomorphic adenoma in palate was more common in females (61.6%), average age was 49 years old (range 9-73 years old). Four patients progressed to malignant transformation. The odds ratio (OR) of detecting a recurrence at 10 (OR = 5.57; 95% confidence interval - 95%CI 1.13-27.52), and 20 years (OR = 18.78; 95%CI 3.18-110.84) after treatment of primary pleomorphic adenoma was significantly higher than at one-year follow-up. CONCLUSIONS: The recurrence of pleomorphic adenoma in palate remains a rare event of late occurrence. It mainly affects middle-aged female and carries a risk of malignant transformation. Although uncommon, patients with palatal pleomorphic adenoma should be warned about the possibility of recurrence or malignant transformation of tumor at advanced ages.

Subgemmal neurogenous plaque of posterolateral region in tongue: A case report and review of literature.

INTRODUCTION: The subgemmal neurogenous plaque is a well-defined subepithelial neural plexus associated with taste buds, located within foliate, fungiform, and circumvallate papillae of the human tongue, that is poorly known by dentists and medical professionals. The hyperplasia of subgemmal neurogenous plaque may occur and it manifests as a papule, nodule, plaque, or ulcer in the lateral posterior border of the tongue inducing the overdiagnosis of reactive, cystic, or neoplastic lesions. The aims of this study are to report a case of a patient with subgemmal neurogenous plaque, and to provide a comprehensive review of other subgemmal neurogenous plaque in the posterolateral tongue with challenging diagnosis. PRESENTATION OF CASE: A 28-year-old female with a little yellowish nodule, asymptomatic, located in posterior left lateral border of the tongue. Accurate diagnosis was based in excisional biopsy and histopathological examination showing a superficial neurofibroma-like pattern, and a neuroma-like in the deep zone. The final diagnosis was subgemmal neurogenous plaque. DISCUSSION: The subgemmal neurogenous plaque has an erythematous nodule or papule in the border of the tongue that are frequently misdiagnosis as foliate papillitis and lymphoepithelial cyst. Despite the subgemmal neurogenous plaque be considered a normal structure, the biopsy is recommended for differential diagnosis with other benign or malignant lesions in tongue. CONCLUSION: Contributing with the dentists and medical professionals in their clinical practice, we reviewed the literature and added a case of subgemmal neurogenous plaque in the posterolateral region of the tongue, highlighting the importance of its recognition to avoid misdiagnosis.

Relevance of Cone-beam computed tomography on diagnosis and surgical planning of the cementoblastoma.

The cementoblastoma is a rare odontogenic tumor occurring in the mandibular molar and premolar of the patients in the second and third decades of life. Despite its typical benign behavior, this tumor may promote local destruction by perforating the cortical bone and displacing the mandibular canal. This case report shows a 31-year-old man with an aggressive cementoblastoma attached to the apex of the mandibular first molar. Cone-beam computed tomography revealed a hyperdense mass connected to the root of mandibular molar surrounded by a hypodense area. Multiplanar reconstructions showed rupture of buccal bone plate and tumor invasion of the mandibular canal roof. The surgical planning included enucleation of tumor with the first and second molars extractions and the diagnosis of cementoblastoma was confirmed by histopathology. This case report emphasizes the contribution of cone-beam computed tomography on diagnosis and appropriate surgical planning of the cementoblastoma. Key words:Cone-Beam computed tomography, odontogenic tumors, diagnosis.

Bilateral jaws involvement of Burkitt's lymphoma in a pediatric patient.

A case of Burkitt's lymphoma with bilateral jaws involvement in a 5-year-old boy is reported discussing the dentist's role in the diagnosis and management of this disease. The initial clinical diagnosis established of maxillary swelling causing trismus was a dentoalveolar abscess. The incisional biopsy was performed and histopathological analysis, including immunohistochemistry, confirmed the Burkitt's lymphoma. The patient underwent treatment and remains free of the disease for 36 months of follow-up. The occurrence of intraoral bilateral jaws involvement of Burkitt's lymphoma in child is unusual and its accurate diagnosis avoids complications in the patient's treatment. Key words:Burkitt's lymphoma, Non-Hodgkin's lymphoma, Oral cavity, Maxilla, Child.

A Rare Case of Intraductal Papilloma Arising from Minor Salivary Gland in the Floor of the Mouth.

A 77-year-old woman with a rare oral intraductal papilloma arising from the minor salivary gland located on the floor of the mouth and causing the mucus retention is reported. Microscopically, the lesion was characterized by unicystic cavity exhibiting the lumen partially filled by papillary projections of the ductal epithelium with varying degree of oncocytic metaplasia. Based on the histopathological analysis, the differential diagnosis of oral intraductal papillomas and other ductal neoplasms of salivary origin are discussed.

Clinical behavior of recurrent pleomorphic adenoma in the palate: a systematic review

Purpose: This systematic review analyzed the clinical behavior and odds of malignancy of the palatal recurrent pleomorphic adenomas. Methods: Systematic review of patients with recurrent pleomorphic adenoma arising in the palate. Database search: MEDLINE, Scopus, Web of Science, Cochrane, EMBASE, Virtual Health Library, Google Scholar, and OpenGrey. A binomial logistic regression was performed to assess the odds of detecting recurrence five, 10 and 20 years after the treatment of primary tumor. Results: Thirteen studies (n = 18 patients) out of 336 were included. The recurrent pleomorphic adenoma in palate was more common in females (61.6%), average age was 49 years old (range 9-73 years old). Four patients progressed to malignant transformation. The odds ratio (OR) of detecting a recurrence at 10 (OR = 5.57; 95% confidence interval - 95%CI 1.13-27.52), and 20 years (OR = 18.78; 95%CI 3.18-110.84) after treatment of primary pleomorphic adenoma was significantly higher than at one-year follow-up. Conclusions: The recurrence of pleomorphic adenoma in palate remains a rare event of late occurrence. It mainly affects middle-aged female and carries a risk of malignant transformation. Although uncommon, patients with palatal pleomorphic adenoma should be warned about the possibility of recurrence or malignant transformation of tumor at advanced ages.

A Case of Oral Histoplasmosis Concomitant with Pulmonary Tuberculosis.

The superficial intraoral lesions of histoplasmosis occurring concomitant to tuberculosis, in a 46-year-old man, are reported. The human immunodeficiency virus (HIV) infection test was negative. The immunosuppression caused by tuberculosis in our patient probably had an important role in the development of intraoral lesions of histoplasmosis. Here, we discussed the role of the dentist in the diagnosis of these infectious diseases, highlighting the importance of anamnesis and the histopathology/immunohistochemistry exams.

Atypical intraosseous mucoepidermoid carcinoma with two years of evolution and cutaneous infiltration.

The intraosseous mucoepidermoid carcinoma is a rare lesion that frequently affects the posterior region of the mandible. This case reports a multilocular osteolytic radiolucency with two years of evolution, that expanded and perforated the cortical bone, with irregular and indefinite margins, that extended from the mandibular angle to the ascendant ramus, with cutaneous ulceration, detected in a 51 years-old male. An incisional biopsy was performed and confirmed the diagnosis of low-grade intraosseous mucoepidermoid carcinoma. The patient was submitted to partial mandibulectomy, neck dissection and post-operative radiotherapy. In three years of follow-up, there was no evidence of tumor recurrence. This case report reinforces that even a low-grade intraosseous mandibular mucoepidermoid carcinoma tends to expand and to perforate the bone cortical, infiltrating to adjacent soft tissues, in long time of evolution. Key words:Intraosseous, mucoepidermoid carcinoma, mandible.

Immunoexpression of proteins involved in cytoskeleton remodeling in benign odontogenic lesions.

OBJECTIVE: The present study was designed to analyze the immunolocalization of proteins involved in cytoskeleton remodeling, such as moesin and Rho-A, in benign odontogenic lesions that present with expansive growth and invasive clinical behavior. MATERIALS AND METHODS: Expressions of moesin and Rho-A in odontogenic epithelium were evaluated by immunohistochemical analysis in 45 odontogenic lesions using monoclonal antibodies. RESULTS: Our results demonstrated strong membranous and cytoplasmic expressions of moesin in the epithelial cells in 66.7% and 44.4% of the odontogenic lesions, respectively. Furthermore, Rho-A expression in odontogenic epithelium was strong in the membrane and cytoplasm of 51.1% and 62.2% of the odontogenic lesions, respectively. A statistically significant correlation was found between the membranous and cytoplasmic expressions of moesin (p = 0.000) and those of Rho-A (p = 0.048) in odontogenic epithelial cells, while no statistically significant correlation was found between moesin and Rho-A expressions (p > 0.05). CONCLUSIONS: The present study confirmed the strong expressions of moesin and Rho-A by odontogenic epithelial cells, suggesting their involvement in the development of benign odontogenic lesions. However, this study has failed to detect the connection between the moesin and Rho-A interaction in expansive growth and local invasiveness of these lesions.

A rare case report of an adenomatoid odontogenic tumor associated with odontoma in the maxilla.

INTRODUCTION: The adenomatoid odontogenic tumor (AOT) associated with odontoma has been described as a new entity with overlapping features of adenomatoid-like structures and odontoma. Presentation of the case: We report the second case of AOT associated with odontoma in the posterior maxillary region. A 22-year-old patient presented expansion of the vestibular and palatine cortical wall of maxilla. Radiographic examination and computed tomography confirmed erosion of maxillary walls, root resorption, displacement of a neighboring tooth and radiopacities within the lesion. Histopathological analysis showed a cystic cavity lined by odontogenic epithelium, organized as duct like structures and tubular dentin. The diagnosis established was AOT associated with odontoma. DISCUSSION: As fewer cases have been described, the aim of this study is to report clinical behavior and evolution of adenomatoid odontogenic tumor associated with odontoma, as it have not yet been described and its origin is not completely established. The hamartomatous or neoplastic origin of this tumor is under debate. CONCLUSIONS: Therefore, it is necessary similar cases to be published to increase the knowledge about the clinical behavior and evolution of this tumor, to enable such lesions to be more clearly defined in the next classification of odontogenic tumors.

Cholesterol Granuloma in the Maxillary Sinus: Are Endodontically Treated Teeth Involved in Its Etiopathogenesis?

Cholesterol granuloma (CG) is a tissue reaction in response to the accumulation of cholesterol crystals rarely found in the maxillary sinus. The etiopathogenesis of maxillary sinus CG remains unclear. We reviewed the literature and added two new reports of cholesterol granuloma in maxillary sinus related to endodontically treated maxillary posterior teeth. The first report refers to a 45-year-old woman diagnosed with rhinitis, who was submitted to endodontic retreatment of maxillary molar, and subsequently showed maxillary sinus opacity with cystic appearance. The second case describes a young adult woman, who presented a cystic mass in maxillary sinus after endodontic treatment, in close association with the apex of the maxillary right second premolar. Both patients were treated by a classic Caldwell-Luc surgery and the microscopic analyses revealed maxillary sinus CG. In the following, the authors discuss the probable involvement of endodontically treated maxillary posterior teeth in the etiopathogenesis of maxillary sinus CG.

Unicystic Ameloblastoma with Mural Proliferation Managed by Conservative Treatment.

Unicystic ameloblastoma is a distinguishable entity of ameloblastomas, characterized by slow growth and being relatively locally aggressive. Three histological types are recognized according to the degree of ameloblastomatous epithelial extension, namely, luminal, intraluminal, and mural types. This classification has a direct bearing on their biological behavior, treatment, and prognosis. However, there is difficulty in determining the most appropriate form of treatment for unicystic ameloblastoma. We present a case of unicystic ameloblastoma that occurred in the right posterior mandible of 19-year-old girl, which was enucleated and did not recur after 12-month follow-up.

Tuberous Sclerosis with Severe Cutaneous Manifestation and Multiples Facial Angiofibromas.

Tuberous sclerosis is an extremely variable disease that can affect virtually any organ in the body. The most common findings are cutaneous manifestations, that are critical features in helping to establish diagnosis. We present a case of young man with diagnosis of tuberous sclerosis presenting multiple shagreen patches around the trunk, in the neck and genital region; large plaques with uneven surfaces on the right side of the lower back; and multiple papular lesions in his face, particularly around the nasolabial region, eyebrows and forehead. Considering that tuberous sclerosis is a disease with a highly variable clinical presentation, thus dentists and doctors should be aware of the different manifestations that may be found.

Kallikrein 4 and matrix metalloproteinase-20 immunoexpression in malignant, benign and infiltrative odontogenic tumors.

CONTEXT: Matrix metalloproteinase-20 (MMP20) (enamelysin) and kallikrein 4 (KLK4) are enzymes secreted by ameloblasts that play an important role in enamel matrix degradation during amelogenesis. However, studies have shown that neoplastic cells can produce such enzymes, which may affect the tumor infiltrative and metastatic behaviors. AIMS: The aim of this study is to assess the biological role of MMP20 and KLK4 in odontogenic tumors. MATERIALS AND METHODS: The enzymes were analyzed immunohistochemically in ameloblastoma, adenomatoid odontogenic tumor (AOT), calcifying epithelial odontogenic tumor, keratocystic odontogenic tumor with or without recurrence and odontogenic carcinoma. STATISTICAL ANALYSIS USED: Clinicopathological parameters were statistically correlated with protein expression using the Fisher's exact test. Kruskal-Wallis and Wilcoxon-independent methods were used to evaluate the differences in median values. RESULTS: Positive Immunoexpression was detected in all benign lesions, with a prevalence of 75-100% immunolabeled cells. Patients were predominantly young, Caucasian, female, with slow-growing tumors located in the mandible causing asymptomatic swelling. No KLK4 expression was seen in carcinomas, and the amount of MMP20-positive cells varied between 20% and 80%. Rapid evolution, recurrence and age >60 years characterized the malignant nature of these lesions. CONCLUSIONS: Data showed that KLK4 and MMP20 enzymes may not be crucial to tumoral infiltrative capacity, especially in malignant tumors, considering the diversity and peculiarity of these lesions. The significant immunoexpression in benign lesions, remarkably in AOT, is likely associated with differentiated tumor cells that can produce and degrade enamel matrix-like substances. This would be expected since the histogenesis of odontogenic tumors commonly comes from epithelium that recently performed a secretory activity in tooth formation.

Focal osteoporotic bone marrow defect involving dental implant: a case report.

In oral implantology, the most serious complications occur intraoperatively or within a short period. We describe an unusual case of focal osteoporotic bone marrow defect involving dental implant in the posterior mandibular region of the adult woman. Despite the fact that this condition requires no treatment, it could lead to the displacement of the dental implant. Additionally, this case report reinforces that histopathological analysis is mandatory for precise diagnosis of the radiolucency into posterior mandibular region of the adult woman associated or not with dental implant placement.