Epstein-Barr Virus-Positive Mucocutaneous Ulcer Mimicking Peri-Implantitis in a Patient With Systemic Lupus Erythematosus.

Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is characterized by cutaneous and/or mucosal ulcers in patients receiving immunosuppressive medication or with age-related immunosenescence. Its microscopic appearance often leads to a diagnostic challenge, sometimes mimicking an overt lymphoma. A 47-year-old woman, with a previous diagnosis of systemic lupus erythematosus, was referred for evaluation of a gingival ulcer, present for about 2 months and located in the maxillary peri-implant mucosa around implants, resembling peri-implantitis. An incisional biopsy was performed, and the microscopic evaluation showed a polymorphic infiltrate with some Reed-Sternberg-like cells. Immunohistochemistry showed positive findings for CD20, CD30, CD45, PAX-5, MUM-1, LMP-1 and EBER1/2, establishing the diagnosis of EBVMCU. After 2 months, total regression of the lesion was noted without any intervention. We discuss the possible association between the EBVMCU and systemic lupus erythematosus; to our knowledge, this is the first report of an EBVMCU simulating peri-implantitis.

Sclerotherapy for Extensive Vascular Malformation in the Tongue.

Vascular malformations (VMs) are benign lesions of blood vessels originated from an error in vascular morphogenesis during the embryologic phase. Generally, when located in the head and neck region VMs occurs in lips, tongue, buccal mucosa, gums, or palate. The VMs are usually asymptomatic, varies in size and may cause facial asymmetries. Different therapeutic modalities are available to treat VMs, which include surgical excision, cautery, cryotherapy, laser therapy, and sclerosing agents. The authors report 2 patients with extensive VM in the tongue treated with intralesional injection of a low-dose solution of monoethanolamine oleate (MO) and lidocaine. The first patient was a 69-year-old male patient and the 2nd a 65-year-old woman. In both patients, it were performed weekly application of 1:1 MO (Ethamolin) with Lidocaine (lidocaine 3% 1:50,000) in the amount of 0.1 mL of the solution per cm3 of lesion, with a total of 12 applications for each patient at the end of the treatment, with good results and without complications. It is important to be alert in which situation sclerotherapy should be used and that small doses of the sclerotherapeutic agent is essential for the prevention of complications after the procedure. Therefore, these patients showed that the sclerotherapy with MO may be an effective and simple treatment for extensive oral benign vascular lesions. In both patients, there was a great improvement in the clinical aspect of the lesions and patient's satisfaction.

Mucoepidermoid Carcinoma of the Hard Palate in a Young Patient.

Carcinomas of salivary glands are rare and can affect major or minor salivary glands. Among them, the mucoepidermoid carcinoma is the most prevalent and its occurrence in the first 2 decades of life is highly unusual. Their common clinical aspect to different diseases is a challenge in diagnosis. The objective of this work is to elucidate the diagnosis of lesion in the hard palate of an adolescent patient, brown-skinned, male, forwarded to the oral surgery department at the State University of Londrina. Initially, he complained about a progressive swelling in the last 60 days. Through computed tomography scan, it was noted intraosseous involvement in the maxilla involving dental apex of the elements 13, 14, 15, right maxillary sinus extending to piriform sinus. Proceeding with clinical examination, followed by biopsy, histology, and immunohistochemical analysis, we established the diagnosis of mucoepidermoid carcinoma. After verification, the patient was sent to the referenced service to start cancer treatment.

Oral squamous cell carcinoma outcome in adolescent/young adult: Systematic review and meta-analysis.

To perform a systematic review focusing on the prognosis of oral cavity squamous cell carcinoma (OSCC) in young patients (≤40 years old) compared to older (>40 years old). Four databases were used in our search strategy. First, all titles were systematically organized using the Covidence platform online. In the second phase, 118 full texts of potentially eligible studies were analyzed by reviewers independently and in pairs. Twelve studies were considered eligible for data extraction. The relapse was higher in the young than in controls (pooled relative risk (RR) = 1.31; 95% CI [1.10-1.56]). The 5-year disease-free survival (DFS) was worse in young group (pooled hazard ratio (HR) = 0.73; 95% CI [0.63-0.85]) but the 5-year overall survival (OS) estimate was similar between the groups (pooled HR = 0.84; 95% CI [0.70-1.00]). While the 5-year OS was similar between groups, the number of relapses and 5-year DFS were worse in patients with OSCC ≤40 years old.

Oral mucoceles: A Brazillian Multicenter Study of 1,901 Cases.

Oral mucocele (OM) is the most common lesion of minor salivary glands. The present study aimed to report the clinical and demographic features of a large series of OMs and identify possible predictive variables associated with the recurrence rate of these lesions. A retrospective descriptive cross-sectional study was performed. A total of 43,754 biopsy records from four pathology services in Brazil were analyzed. All cases of OMs were reviewed, and clinical and demographic data were collected. The study comprised 1,002 females (56.2%) and 782 males (43.8%), with a mean age of 19.8±16.4 years (range: 01-87 years) and a 1.3:1 female-to-male ratio. The lower lip (n=1,160; 67.4%), and floor of the mouth (n=172; 10.0%), were the most common affected sites, presenting clinically as nodules (n=978; 79.4%) of smooth surface (n=428; 77.5%) and normal color (n=768, 46.7%). Excisional biopsy was the treatment in most cases (n=1,392; 78.0%). Recurrent OMs represented 6.2% of all diagnosed cases (n=117). OMs recurred more commonly in younger patients (aged<20 years) (p<0.0001), in lesions larger than 2 cm in diameter (p<0.0001), and in those located in the ventral tongue (p=0.0351). Also, recurrence rates were higher significantly in cases treated with laser surgery than in those with conventional surgery (p=0.0005). Patients with OMs should be carefully informed of its possible recurrence, especially when found on the ventral tongue of young patients.

Widespread Sporadic Type Burkitt Lymphoma Presenting as Dental Mobility and Premature Eruption of Permanent Teeth in a Child.

Burkitt lymphoma (BL) is a rare and aggressive malignant neoplasm frequently involving the jawbones in children. The main purpose of this article is to report the case of a nine-year-old boy with widespread BL diagnosed through oral findings. The patient was referred after complaining of dental mobility for two weeks. The physical examination revealed premature eruption of permanent teeth. The periapical radiographic examination showed a diffuse bone rarefaction in the involved area. An incisional biopsy was performed, leading to the diagnosis of BL. The patient was then treated with chemotherapy and is free of disease after an 18-month follow-up. The main signs and symptoms of an oral BL could mimic a dental problem, thus it is extremely important to be knowledgeable about this disease, which can be fatal without early diagnosis and treatment.

Histopathological findings of pleomorphic adenomas of the salivary glands.

OBJECTIVES: To describe the histopathological features of pleomorphic adenoma (PA) with special reference to the epithelial and mesenchymal components. STUDY DESIGN: 189 PA were selected and classified as myxoid or stroma-rich, cellular or cell-rich and classic (balanced amount of epithelial and stromal components). The epithelial component was analyzed according to the presence of plasmacytoid, spindle, clear, squamous, basaloid, cubic, oncocytoid and mucous cells and the morphological pattern (trabecular, ductal, cystic and solid). The stromal component was analyzed according to the presence of myxoid, hyaline, chondroid or calcified tissue. RESULTS: Plasmacytoid cells were the most commonly found cellular type followed by fusiform and cuboidal cells. Trabeculae and duct-like structures were the most frequent patterns formed by the epithelial cells. Myxoid and chondroid stroma were the most frequently found mesenchymal-like tissue usually forming the so called myxochondroid stroma. CONCLUSION: The knowledge of the immense variety of cells, architectures and morphological characteristics present in PA of the salivary gland is essential for a correct diagnosis.

Oral Manifestation as the Main Sign of an Advanced Stage Acute Promyelocytic Leukemia.

Acute myeloid leukemia is an aggressive malignant neoplasm occurring mainly in elderly, with the median age of 65 years. Oral manifestations, mainly spontaneous bleeding, are a common finding in acute myelocytic leukemia and may represent the initial evidence of the disease. This report describes a case of a 47-year-old man with a one-month history of spontaneous oral bleeding. The patient had already been consulted by two professionals but he remained undiagnosed. The physical examination revealed paleness, fever, epistaxis and ecchymoses in the oral mucosa. The complete blood count revealed anemia, severe thrombocytopenia and leukocytosis with blasts predominance, reinforcing the diagnosis hypothesis of an acute leukemia. The patient was immediately referred to the Hospital and despite having received a quick intervention, he died 3 days after the admission due to diffuse pulmonary alveolar hemorrhage. According to the peripheral blood immunophenotyping the diagnosis of hypogranular variant of acute promyelocytic leukemia was established. The delay in the diagnosis may have influenced the unfavorable outcome. Early diagnosis and management are indispensable for survival of leukemia patients. In this way, dentists may be responsible for an early detection of oral manifestations of leukemia and for a fast referral to an adequate professional.

Oral mucoceles: A Brazillian Multicenter Study of 1,901 Cases

Abstract Oral mucocele (OM) is the most common lesion of minor salivary glands. The present study aimed to report the clinical and demographic features of a large series of OMs and identify possible predictive variables associated with the recurrence rate of these lesions. A retrospective descriptive cross-sectional study was performed. A total of 43,754 biopsy records from four pathology services in Brazil were analyzed. All cases of OMs were reviewed, and clinical and demographic data were collected. The study comprised 1,002 females (56.2%) and 782 males (43.8%), with a mean age of 19.8±16.4 years (range: 01-87 years) and a 1.3:1 female-to-male ratio. The lower lip (n=1,160; 67.4%), and floor of the mouth (n=172; 10.0%), were the most common affected sites, presenting clinically as nodules (n=978; 79.4%) of smooth surface (n=428; 77.5%) and normal color (n=768, 46.7%). Excisional biopsy was the treatment in most cases (n=1,392; 78.0%). Recurrent OMs represented 6.2% of all diagnosed cases (n=117). OMs recurred more commonly in younger patients (aged<20 years) (p<0.0001), in lesions larger than 2 cm in diameter (p<0.0001), and in those located in the ventral tongue (p=0.0351). Also, recurrence rates were higher significantly in cases treated with laser surgery than in those with conventional surgery (p=0.0005). Patients with OMs should be carefully informed of its possible recurrence, especially when found on the ventral tongue of young patients.

Resumo A mucocele oral (MO) é a lesão mais comum das glândulas salivares menores. O presente estudo teve como objetivo relatar as características clínicas e demográficas de uma grande série de MOs e identificar possíveis variáveis preditivas associadas à taxa de recorrência dessas lesões. Foi realizado um estudo transversal descritivo retrospectivo. Foram analisados 43.754 registros de biópsias de quatro serviços de patologia no Brasil. Todos os casos diagnosticados como MOs foram revisados e dados clínicos e demográficos foram coletados. Participaram do estudo 1.002 mulheres (56,2%) e 782 homens (43,8%), com média de idade de 19,8 ± 16,4 anos (variação: 01-87 anos) e proporção de mulheres para homens de 1,3:1. O lábio inferior (n=1.160; 67,4%) e assoalho da boca (n=172; 10,0%), foram os locais mais acometidos, apresentando-se clinicamente como nódulos (n=978; 79,4%) de superfície lisa (n =428; 77,5%) e coloração normal (n=768, 46,7%). A biópsia excisional foi o tratamento na maioria dos casos (n=1.392; 78,0%). As MOs recorrentes representaram 6,2% de todos os casos diagnosticados (n = 117). As recorrências recorreram mais comumente em pacientes mais jovens (idade < 20 anos) (p < 0,0001), em lesões maiores que 2 cm de diâmetro (p < 0,0001) e naquelas localizadas na superfície ventral da língua (p = 0,0351). Além disso, as taxas de recorrência foram significativamente maiores nos casos tratados com cirurgia a laser do que aqueles com cirurgia convencional utilizando bisturi (p = 0,0005). Pacientes com mucoceles devem ser informados sobre uma possível recorrência, principalmente quando encontrados no lábio ou assoalho bucal de pacientes jovens.

Rare presentation of adenomatoid odontogenic tumor in a pediatric patient: a case report.

The adenomatoid odontogenic tumor (AOT) is a painless benign tumor with slow growth, usually asymptomatic. It has three variants: follicular, extrafollicular, and peripheral. In the follicular type, the tumor is associated with an impacted tooth, and maxillary canines are the most frequently affected. Association with primary teeth is very rare. Treatment consists essentially in a total lesion enucleation. The objective of this paper is to present the clinical case of a 7-year-old female patient with an adenomatoid odontogenic tumor associated with the crown of the left lower deciduous canine (73), dislodging it to the mandibular base and consequently shifting and also impacting the permanent lower canine (33). The lesion was treated with careful enucleation, preserving the permanent canine, which then had its eruption path released favoring its migration to an ideal position.

Syphilis Diagnosis through Oral Lesions of Different Clinical Aspects: Report of 3 Cases / Diagnóstico de Sífilis Através de Lesões Bucais de Diferentes Aspectos Clínicos: Relato de 3 Casos

Syphilis is a sexually transmitted infection, caused by the anaerobic spirochete Treponema pallidum. It is characterized by a variety of clinical manifestations including the oral mucosa, mimicking several diseases, thereby making diagnosis a challenge for clinicians. Therefore, the objective of this work is to report three cases of syphilis that were diagnosed based on oral lesions of different clinical aspects. In this series of cases, the lesions were found on the tongue and hard palate and presented as white plaques, ulcers or erythematous spots associated with ulcers. In the two cases, incisional biopsy was performed, and the histopathological aspects were suggestive of syphilis. Treponemic and nontreponemic tests were positive for all the patients, confirming syphilis. Therapy with benzathine-penicillin, administered intramuscularly led to complete remission of oral lesions in all the patients. The syphilis reemergence in the last years demands its inclusion in the differential diagnosis of several oral lesions. Diagnosing syphilis by oral lesions can be difficult once it can mimic other conditions. Therefore, dentists should know the clinical aspects of this infection, since many cases may exhibit only oral manifestations, to help in the diagnosis and control of the infection spread. (AU)

A sífilis é uma infecção sexualmente transmissível, causada pela espiroqueta anaeróbia Treponema pallidum. É caracterizada por uma variedade de manifestações clínicas, incluindo a mucosa oral, podendo mimetizar várias doenças, tornando o diagnóstico um desafio. Portanto, o objetivo deste trabalho é relatar três casos de sífilis diagnosticados a partir de lesões orais de diferentes aspectos clínicos. Nesta série de casos, as lesões foram encontradas na língua e palato duro e apresentadas como placas brancas, úlceras ou manchas eritematosas associadas a úlceras. Em dois casos, foi realizada biópsia incisional e os aspectos histopatológicos foram sugestivos de sífilis. Os testes treponêmicos e não treponêmicos foram positivos para todos os pacientes, confirmando a sífilis. A terapia com penicilina benzatina, administrada por via intramuscular, levou à remissão completa das lesões orais em todos os pacientes. O ressurgimento da sífilis nos últimos anos exige sua inclusão no diagnóstico diferencial de várias lesões bucais. O diagnóstico da sífilis por lesões orais pode ser difícil, pois pode mimetizar outras condições. Portanto, o dentista deve conhecer os aspectos clínicos dessa infecção, pois muitos casos podem apresentar apenas manifestações orais, para auxiliar no diagnóstico e controle da disseminação da infecção. (AU)

Tenebrio molitor (Coleoptera: Tenebrionidae) as an alternative host to study fungal infections.

Models of host­pathogen interactions are crucial for the analysis of microbial pathogenesis. In this context, invertebrate hosts, including Drosophila melanogaster (fruit fly), Caenorhabditis elegans (nematode) and Galleria mellonella (moth), have been used to study the pathogenesis of fungi and bacteria. Each of these organisms offers distinct benefits in elucidating host­pathogen interactions. In this study,we present a newinvertebrate infection model to study fungal infections: the Tenebrio molitor (beetle) larvae. Here we performed T. molitor larvae infection with one of two important fungal human pathogens, Candida albicans or Cryptococcus neoformans, and analyzed survival curves and larva infected tissues.We showed that increasing concentrations of inoculum of both fungi resulted in increased mortality rates, demonstrating the efficiency of the method to evaluate the virulence of pathogenic yeasts. Additionally, following 12 h post-infection, C. albicans formsmycelia, spreading its hyphae through the larva tissue,whilst GMS stain enabled the visualization of C. neoformans yeast and theirmelanin capsule. These larvae are easier to cultivate in the laboratory than G. mellonella larvae, and offer the same benefits. Therefore, this insect model could be a useful alternative tool to screen clinical pathogenic yeast strainswith distinct virulence traits or different mutant strains.

Calcifications may be a frequent finding in mucoepidermoid carcinomas of the salivary glands: a clinicopathologic study.

Calcifications in mucoepidermoid carcinoma (MEC) of the salivary glands are considered to be exceptionally rare and are often associated with high-grade tumors. This study reviewed 30 cases of MECs to access the frequency of calcifications and the clinical profile of the patients and histopathologic aspects of the tumors. In total, 6 cases of calcifications (20%) were identified. Five patients were women and 1 was a man, patients' ages ranged from 22 to 69 years old, and calcifications were found in conventional and clear cell-type MECs. Areas of calcification showed positivity for periodic acid-Schiff and mucicarmine, supporting the hypothesis that they originate from the precipitation of mucous secretion. The presence of calcifications in MECs was independent of the histologic grade of the tumors and the histopathologic variants. Calcifications in salivary MECs may not be as rare as previously mentioned in the literature and may be not associated with high-grade tumors.

Immunohistochemical study of androgen, estrogen and progesterone receptors in salivary gland tumors.

The aim of this work was to study the immunohistochemical expression of androgen receptor, estrogen receptor and progesterone receptor in pleomorphic adenomas, Warthin's tumors, mucoepidermoid carcinomas and adenoid cystic carcinomas of salivary glands. A total of 41 pleomorphic adenomas, 30 Warthin's tumors, 30 mucoepidermoid carcinomas and 30 adenoid cystic carcinomas were analyzed, and the immunohistochemical expression of these hormone receptors were assessed. It was observed that all cases were negative for estrogen and progesterone receptors. Androgen receptor was positive in 2 cases each of pleomorphic adenoma, mucoepidermoid carcinoma and adenoid cystic carcinoma. In conclusion, the results do not support a role of estrogen and progesterone in the tumorigenesis of pleomorphic adenomas, Warthin's tumors, mucoepidermoid carcinomas and adenoid cystic carcinomas. However, androgen receptors can play a role in a small set of salivary gland tumors, and this would deserve further studies.

Proteção da integridade e da autenticidade das radiografias odontológicas digitais / Integrity and authenticity's protections of digital dental radiographs

A radiografia digital pode ser usada na odontologia em substituição ao sistema convencional, que utiliza filme para aquisição de imagens diagnósticas. Se comparada com esse sistema, a radiografia digital apresenta vantagens, como menor tempo para aquisição da imagem, eliminação do processamento, possibilidade de melhora na qualidade da imagem após a exposição aos raios-x e menor exposição do paciente à radiação. O sistema digital tem também desvantagens, sendo uma das mais significativas a possibilidade de alteração maliciosa das imagens por meio de programas gráficos, e, assim, o valor legal das radiografias, que antes era inquestionável, passou a ser discutível judicialmente, devido a essa possibilidade de manipulação. Este artigo é uma revisão de literatura que apresenta uma visão geral sobre radiografia digital odontológica e algumas técnicas que foram desenvolvidas e ainda causam interesse na comunidade de pesquisa, para garantir autenticidade, confiabilidade e integridade às imagens digitais adquiridas, transmitidas e armazenadas. O seu objetivo é que o cirurgião-dentista possa conhecer essa nova opção em aquisição de imagens diagnósticas e estar ciente de algumas alternativas de proteção de dados digitais, como técnicas criptográficas e de assinatura digital, Digital Imaging and Communication in Medicine, e os princípios de marca d´água digital.

Digital radiography can be used in dentistry as a substitute of the conventional system which uses radiographic film for the attainment of diagnostic images. If compared with the conventional system, digital radiography presents advantages such as shorter amount of time for the acquirement of images, possibility of an enhancement of the image quality after the exposure to the x-rays and less exposure of the patients to the x-rays. The digital system, however, has disadvantages and the most significant one is the possibility of malicious alteration of the images through graphic programs, that being, the legal value which used to be unquestionable, became judiciously debatable due to this possibility of manipulation. This article presents an overview of dental radiographs and some of the techniques that still cause interest within the research community developed to assure the authenticity, trustworthiness and integrity of the attainment, transmission and storage of digital images. The objective is that the dentists obtain knowledge about this new option of attainment of diagnosed images and becomes aware of some of the digital data protection's alternatives such as cryptography techniques and digital signatures, Digital Imaging and Communication in Medicine and the principles of digital watermarking.

Immunohistochemical study of androgen, estrogen and progesterone receptors in salivary gland tumors

The aim of this work was to study the immunohistochemical expression of androgen receptor, estrogen receptor and progesterone receptor in pleomorphic adenomas, Warthin's tumors, mucoepidermoid carcinomas and adenoid cystic carcinomas of salivary glands. A total of 41 pleomorphic adenomas, 30 Warthin's tumors, 30 mucoepidermoid carcinomas and 30 adenoid cystic carcinomas were analyzed, and the immunohistochemical expression of these hormone receptors were assessed. It was observed that all cases were negative for estrogen and progesterone receptors. Androgen receptor was positive in 2 cases each of pleomorphic adenoma, mucoepidermoid carcinoma and adenoid cystic carcinoma. In conclusion, the results do not support a role of estrogen and progesterone in the tumorigenesis of pleomorphic adenomas, Warthin's tumors, mucoepidermoid carcinomas and adenoid cystic carcinomas. However, androgen receptors can play a role in a small set of salivary gland tumors, and this would deserve further studies.

Histopathological findings of pleomorphic adenomas of the salivary glands

Objectives: To describe the histopathological features of pleomorphic adenoma (PA) with special reference tothe epithelial and mesenchymal components. Study design: 189 PA were selected and classified as myxoid orstroma-rich, cellular or cell-rich and classic (balanced amount of epithelial and stromal components). The epithelialcomponent was analyzed according to the presence of plasmacytoid, spindle, clear, squamous, basaloid, cubic,oncocytoid and mucous cells and the morphological pattern (trabecular, ductal, cystic and solid). The stromalcomponent was analyzed according to the presence of myxoid, hyaline, chondroid or calcified tissue. Results:Plasmacytoid cells were the most commonly found cellular type followed by fusiform and cuboidal cells. Trabeculaeand duct-like structures were the most frequent patterns formed by the epithelial cells. Myxoid and chondroidstroma were the most frequently found mesenchymal-like tissue usually forming the so called myxochondroidstroma. Conclusion: The knowledge of the immense variety of cells, architectures and morphological characteristicspresent in PA of the salivary gland is essential for a correct diagnosis (AU)