Uncommon Pigmented Carcinoma In Situ: Case Report and Brief Review.

Pigmented lesions of the oral mucosa encompass several benign and malignant conditions that may be a matter of concern under both clinical and histopathological views. We reported a case of a 62-year-old woman, presenting with an asymptomatic, deeply pigmented lesion on the soft palate. On examination, it appeared asymmetrical, with irregular borders and an area of ulceration. A biopsy, taken to rule out melanoma, revealed a pigmented carcinoma in situ. Throughout the tumor thickness, numerous interspersed melanocytes were found that did not extend to neighboring epithelium. These were large, richly dendritic, and presented abundance of melanin granules and small nuclei. Mild melanin incontinence was found. Scanty transfer of pigment to dysplastic epithelial cells was found through Fontana Masson staining. On immunohistochemical analyses, there were pancytokeratin-stained tumor epithelial cells; increased cell proliferation throughout the entire thickness of the tumor was emphasized by Ki-67 immunomarking. P16 was negative. The dendritic cells were selectively stained for S-100, HMB45 and Melan A. Wide spectrum in situ hybridization for human papillomavirus (HPV) was negative. Unfortunately, following diagnosis, the patient refused any treatment option. Pigmented squamous cell carcinoma with melanocyte colonization must be taken into account in the differential diagnosis of pigmented lesions of the oral cavity.

In Situ Melanoma of the Gingiva Associated with Dense Inflammation and Pigment Deposition: A Potential Diagnostic Pitfall in Evaluating Stromal Invasion.

Melanoma is a highly aggressive neoplasm in which the neoplastic cells display melanocytic differentiation. Less than 1 % of all melanomas arise in the mucosal surfaces of the oral cavity, with purely in situ lesions being exceedingly rare tumors, but with a favorable prognosis compared with invasive lesions. We describe the clinical, histopathological and immunohistochemical findings in an uncommon case of in situ mucosal melanoma of the oral cavity with intense tumor-associated pigment deposition and inflammation complicating the morphological assessment of infiltrative areas.

A rare presentation of multiple talon cusps / Uma rara apresentação de múltiplas cúspides em garra

A talon cusp is a relatively rare dental developmental anomaly characterized by the presence of accessory cusp-like structure projecting from the cingulum area or cementoenamel junction. It is frequently found on the palatal surface of the maxillary anterior teeth in the permanent dentition. The etiology is controversial, but it is suggested that this condition has a multifactorial cause, including both genetic and environmental factors. Radiographically talon cusps are radiopaque structures, in which the enamel, dentin and occasionally the pulp can be seen. The alteration is generally asymptomatic, but it may cause clinical problems eventually. Early diagnosis is important to prevent occlusal interference, irritation of the tongue, pulpal necrosis, caries and periodontal alterations. Clinical management of talon cusps may be either conservative or radical, depending on the size and shape of the affected tooth. We report a rare case of talon cusps involving all six maxillary anterior teeth in a 20-year-old patient.

Cúspide em garra é uma anomalia dental do desenvolvimento relativamente rara caracterizada por uma estrutura acessória em forma de cúspide projetando-se da área do cíngulo ou junção amelocementária. Ela é frequentemente encontrada na face palatina dos dentes maxilares anteriores na dentição permanente. A etiologia é controversa, mas é sugerido que essa condição tem causa multifatorial, incluindo ambos os fatores, genéticos e ambientais. Radiograficamente cúspides em garra são estruturas radiopacas, nas quais o esmalte, dentina e ocasionalmente a polpa podem ser vistos. A alteração é geralmente assintomática, mas pode causar problemas clínicos eventualmente. O diagnóstico precoce é importante para prevenir interferência oclusal, irritação na língua, necrose pulpar, cáries e alteração periodontal. O manejo clínico das cúspides em garra pode ser tanto conservativo quanto radical, dependendo do tamanho e forma do dente afetado. Nós relatamos um raro caso de cúspides em garra envolvendo todos os 6 dentes maxilares anteriores em um paciente de 20 anos de idade.

Tongue hyperpigmentation resulting from peginterferon alfa and ribavirin combination therapy: a case report.

BACKGROUND: Tongue hyperpigmentation is a rare side effect in patients with hepatitis C virus infection who are receiving peginterferon alfa and ribavirin combination therapy. Tongue hyperpigmentation usually occurs after the patient has undergone several months of treatment, and it resolves after the patient discontinues therapy. CASE DESCRIPTION: A 66-year-old dark-skinned woman with hepatitis C virus infection was referred to the Oral Diseases Treatment Center of São Leopoldo Mandic Dental School, Campinas, Brazil, for evaluation of tongue pigmentation after receiving peginterferon alfa and ribavirin combination therapy for 32 weeks. A physical examination showed dark brown, asymptomatic pigmentation in the dorsum of the tongue. Six months after the patient discontinued therapy, the authors observed a marked reduction in the pigmentation's intensity. CASE IMPLICATIONS: Dentists should be aware that hyperpigmentation of the tongue can result from peginterferon alfa and ribavirin combination therapy. A biopsy should be performed if no firm diagnosis can be obtained from clinical findings and the patient's medical history.

Prevalence of patients harboring temporomandibular disorders in an otorhinolaryngology department.

UNLABELLED: The interaction between temporomandibular disorders (TMD) and otalgia is, even nowadays, a reason for speculation and hypotheses raising. Several researchers suggest causes, consequences and alleged treatments. STUDY DESIGN: This is an epidemiological, sectional cohort study of prevalence. AIM: The study demonstrates the prevalence of patients harboring TMDs in an otorhinolaryngology department. MATERIAL AND METHODS: During a two-month period, 221 patients from the Otorhinolaryngology Department of the Hospital da Cidade de Passo Fundo, State of Rio Grande do Sul, Brazil were analyzed. A previously validated questionnaire was applied for data collection. RESULTS: In the present study, the need for dental assessment was observed in 48 patients ( 21.72%). In this group there were 35 female (72.9%) and 13 males (27.1%). Only 15 patients (7.24%) were entirely free of TMD symptoms. The remaining patients reported the following TMD symptoms: headaches: 34.39%, neck and shoulder pain: 28.50%, pain on the ear region: 30.32% and joint noises in 23.98%. CONCLUSION: The prevalence of temporomandibular disorders was 21.72%, being significantly higher among female subjects (p:0.0001). The prevalence regarding the indexes, was: TMD absent: 37.56%; mild TMD: 40.72%; moderate TMD 19% and severe TMD: 2.72%.

Prevalência de portadores de DTM em pacientes avaliados no setor de otorrinolaringologia / Prevalence of patients harboring temporomandibular disorders in an otorhinolaryngology departament

A interação entre disfunção temporomandibular e otalgia é, mesmo nos dias atuais, motivo para especulações e hipóteses. Vários pesquisadores sugerem causas, conseqüências e supostos tratamentos. OBJETIVO: Verificar a prevalência de pacientes portadores de DTM em um serviço de otorrinolaringologia. TIPO DE ESTUDO: Este é um estudo epidemiológico do tipo descritivo com amostra transversal. MATERIAL E MÉTODO: Foram avaliados 221 pacientes do Serviço de Otorrinolaringologia do Hospital da Cidade, em Passo Fundo, Rio Grande do Sul, durante um período de dois meses. Para captação e interpretação dos dados, bem como verificação da disfunção temporomandibular, foi utilizado um questionário auto-aplicado previamente validado. RESULTADO: Após coleta e interpretação dos dados de 221 pacientes, os resultados obtidos foram: 48 pacientes (21.72 por cento) considerados como necessitando de tratamento para DTM (índice de DTM moderada e severa), dos quais 35 pertenciam ao gênero feminino (72.9 por cento) e 13 ao masculino (21.1 por cento). Apenas 15 indivíduos do total (7.24 por cento) estavam totalmente livres de sintomas de DTM. Quanto aos demais, apresentaram: dor de cabeça (33,5 por cento), dor no pescoço e ombro (28,5 por cento), dor na região do ouvido (29 por cento) e ruídos articulares (25 por cento). CONCLUSÃO: A prevalência de DTM foi de 21.72 por cento sendo significantemente maior no gênero feminino (p: 0.0001); e as prevalências, em relação aos índices, foram: DTM ausente 37.56 por cento; DTM leve 40.72 por cento; DTM moderada 19 por cento, e DTM severa 2.72 por cento.

The interaction between Temporomandibular disorders (TMD) and otalgia is, even nowadays, a reason for speculation and hypotheses raising. Several researchers suggest causes, consequences and alleged treatments. STUDY DESIGN: This is an epidemiological, sectional cohort study of prevalence. AIM: The study demonstrates the prevalence of patients harboring TMDs in an otorhinolaryngology department. MATERIAL AND METHODOS: During a two-month period, 221 patients from the Otorhinolaryngology Department of the Hospital da Cidade de Passo Fundo, State of Rio Grande do Sul, Brazil were analyzed. A previously validated questionnaire was applied for data collection. RESULTS: In the present study, the need for dental assessment was observed in 48 patients ( 21.72 percent). In this group there were 35 female (72.9 percent) and 13 males (27.1 percent). Only 15 patients (7.24 percent) were entirely free of TMD symptoms. The remaining patients reported the following TMD symptoms: headaches: 34.39 percent, neck and shoulder pain: 28.50 percent, pain on the ear region: 30.32 percent and joint noises in 23.98 percent. CONCLUSION: The prevalence of Temporomandibular disorders was 21.72 percent, being significantly higher among female subjects (p:0.0001). The prevalence regarding the indexes, was: TMD absent: 37.56 percent; mild TMD: 40.72 percent; moderate TMD 19 percent and severe TMD: 2.72 percent.

Estudo clínico, laboratorial e terapêutico da candisose oral em pacientes com sistema imunológico deprimido pelo HIV / Clinical, laboratorial and therapeutical study of oral candidosis in HIV compromised patients

A Candidose oral é uma das infecçöes fúngicas mais freqüentes em pacientes HIV positivos e portadores da AIDS. Durante a infecçäo pelo HIV, o paciente apresenta inúmeros episódios de Candidose oral. Inicialmente, essa infecçäo apresenta-se localizada na mucosa oral, de forma assintomática e de pequena dimensäo, por fim torna-se invasiva, atingindo a mucosa do palato e regiäo orofaríngea e esofágica, e resiste freqüentemente aos antifúngicos usuais. Avaliou-se neste trabalho, a freqüência do aspecto clínico da Candidose oral, e concluíu-se que a forma pseudomembranosa é mais freqüente. Avaliou-se também, através de estudo microbiológico, o material removido da lesäo, para identificaçäo das espécies do fungo. Concluíu-se que a espécie mais freqüente é a C. albicans. Pediu-se exames complementares, para avaliar o perfil imunológico dos pacientes. Constatou-se que os pacientes apresentavam-se com o sistema imunológico deprimido pelo HIV. Avaliou-se ainda a eficácia do medicamento itraconazol. Constatou-se que foi de grande valia, na terapêutica das lesöes resistentes aos antifúngicos usuais