Verruciform xanthoma associated with lichen planus

Verruciform xanthoma (VX) is a rare benign lesion of unknown etiology, with a rough or papillary aspect, painless, sessile, well-defined, most lesions do not exceed 2 cm in their largest diameter, the degree of keratinization of the surface influences color, varying white to red, affecting mainly the gingiva and alveolar mucosa, and can also be seen in skin and genital. Herein, we present a report a clinical case of oral verruciform xanthoma in the buccal mucosa associated with the lichen planus lesion, as well as the morphological and immunohistochemical characteristics of the lesion. The clinical diagnostic hypothesis of oral lichen planus of the white reticular lesions on the buccal mucosa and on the tongue was confirmed by histopathology before a subepithelial connective tissue exhibiting intense inflammatory infiltrate in a predominantly lymphocytic band. In contrast, the hypothesis of the verrucous lesion in the left buccal mucosa was leukoplakia, with histopathological evidence showing exophytic and digitiform proliferations with parakeratin plugs between the papillary projections. Subepithelial connective tissue was characterized by macrophages with foamy cytoplasm (xanthoma cells). An immunohistochemical examination was performed, showing positivity for CD68, a macrophage marker, in addition to testing by Schiff's periodic acid (PAS) with diastasis, which was detected the presence of lipids inside these macrophages. The patient is free of recurrences of verruciform xanthoma and is being monitored due to the presence of lesions of oral lichen planus.

Langerhans Cells Correlate With Macrophages for Defense Mechanisms in the Atrophic Epithelium of Radicular Cysts.

Langerhans cells (LCs) play important roles in cell-mediated immune reactions, as well as in the pathogenesis of periapical lesions. The aim of this study is to evaluate the role of LCs in the proliferative epithelium of radicular cysts (RCs) and the release of the proinflammatory cytokine tumor necrosis factor α (TNF-α) associated with epithelial thickness. Thirty cases of RCs and 30 cases of residual RCs were randomly selected. Morphologic analysis was performed to evaluate the association between the inflammatory infiltrate, cystic epithelial thickness and lesion size, in addition to immunohistochemical assessment of CD1a, CD68, and TNF-α. The highest macrophage percentages and TNF-α scores were found in RCs (P=0.038 and 0.017, respectively). The largest number of LCs was observed in RCs (P=0.021), especially those exhibiting atrophic epithelium (P=0.05). In addition, LCs were positively correlated with the number of macrophages in both RCs and residual RCs (P=0.033 and 0.002, respectively). In contrast to LCs, the largest number of macrophages was detected in cases with an intense inflammatory infiltrate (P=0.022). In addition, the highest TNF-α scores were associated with an intense inflammatory infiltrate (P=0.024) when analyzed in the capsule of RCs (P=0.017). In conclusion, LCs participate in defense mechanisms and were present in all cases evaluated. Along with macrophages, these cells release proinflammatory cytokines such as TNF-α, which is responsible for inducing the continued proliferation of cystic epithelium.

Cystadenoma in a pediatric patient: a rare salivary gland neoplasm / Cistadenoma em paciente pediátrico: uma rara neoplasia de glândula salivar

ABSTRACT Salivary gland cystadenoma is a rare benign neoplasm, representing 1.4% of all benign salivary gland tumors. It presents a predilection for the major salivary gland and middle-aged or elderly adults. The present study reports a rare case of cystadenoma in the floor of the mouth a 5-year-old male patient, who was referred to an oral diagnosis center for evaluation of the lesion. After performing an incisional biopsy, microscopic analysis revealed a cystadenoma. The patient's treatment was excision of the lesion and he has been under follow-up for one year with no signs of recurrence.

RESUMEN El cistoadenoma de las glándulas salivales es una neoplasia benigna rara, responsable del 1,4% de todos los tumores benignos de las glándulas salivales. Tiene predilección por la glándula salival mayor y los adultos de mediana edad o ancianos. El presente estudio reporta un caso raro de cistoadenoma en piso de la cavidad oral de un paciente masculino de 5 años, quien fue derivado a un centro de diagnóstico oral para evaluación de la lesión. Después de realizar una biopsia incisional, el análisis microscópico reveló un cistoadenoma. El paciente fue tratado con la escisión de la lesión y ha sido seguido durante un año sin signos de recidiva.

RESUMO O cistadenoma de glândula salivar é uma neoplasia benigna rara; representa 1,4% de todos os tumores benignos de glândula salivar. Apresenta predileção pela glândula salivar maior e por adultos de meia idade ou idosos. O presente estudo relata um caso raro de cistadenoma em assoalho bucal de um paciente do sexo masculino, 5 anos de idade, que foi encaminhado a um centro de diagnóstico oral para avaliação da lesão. Após realização de biópsia incisional, a análise microscópica revelou um cistadenoma. O tratamento do paciente foi a excisão da lesão, e ele se encontra em acompanhamento há um ano sem sinais de recidiva.

Parotid follicular lymphoid hyperplasia - a rare entity: the challenges in differential diagnosis / Hiperplasia linfoide folicular em parótida - uma rara entidade: os desafios no diagnóstico diferencial

ABSTRACT A 61-year-old female patient presented a nodular lesion located in the right buccal mucosa with a 3-month evolution. Clinical hypotheses of salivary duct cyst and mucocele were proposed, and the patient underwent excisional biopsy. Microscopically, a well-circumscribed and encapsulated lymphoid aggregate fragment was observed, characterized by layers of well-differentiated small lymphocytes and collections of reactive lymphoblasts. These findings, associated with immunohistochemistry, established the diagnosis of follicular lymphoid hyperplasia. Currently, the patient is well, under follow-up after six months.

RESUMEN Paciente del sexo femenino de 61 años de edad exhibió lesión nodular localizada en mucosa yugal derecha con tiempo de evolución de tres meses. Se establecieron las hipótesis clínicas de quiste del ducto salival y mucocele, y la paciente se sometió a una biopsia excisional. Microscópicamente, se observó un fragmento de agregado linfoide bien circunscrito y encapsulado, caracterizado por capas de linfocitos pequeños bien diferenciados y colecciones de linfoblastos reactivos. Esos hallazgos, asociados al estudio inmunohistoquímico, basaron el diagnóstico de hiperplasia folicular linfoide. Al presente, la paciente se encuentra bien, bajo seguimiento seis meses después.

RESUMO Paciente do sexo feminino, 61 anos de idade, exibiu lesão nodular localizada em mucosa jugal direita com evolução há três meses. As hipóteses clínicas de cisto do ducto salivar e mucocele foram estabelecidas, e a paciente foi submetida à biópsia excisional. Microscopicamente, foi observado fragmento de agregado linfoide bem circunscrito e encapsulado, caracterizado por camadas de pequenos linfócitos bem diferenciados e coleções de linfoblastos reativos. Esses achados, associados ao estudo imuno-histoquímico, estabeleceram o diagnóstico de hiperplasia linfoide folicular. Atualmente, a paciente encontra-se bem, sob proservação após seis meses.

Avaliação morfológica e imuno-histoquímica do potencial proliferativo epitelial das lesões císticas odontogênicas agressivas / Morphological and immunohistochemical evaluation of the epithelial proliferative potential of aggressive odontogenic cystic lesions

INTRODUÇÃO: Os cistos odontogênicos são conhecidos pelo seu potencial de crescimento e reabsorção óssea dos ossos gnáticos, que variam de indolentes a agressivas, independente de sua histogênese, vinculada aos remanescentes epiteliais, ectomesenquimais e/ou mesenquimais da odontogênese. Estas lesões em sua maioria, apresentam patogênese controversa, motivo pelo qual estimulam numerosas investigações sobre a possível relação entre o epitélio odontogênico e o desenvolvimento destas lesões. OBJETIVO: Analisar os diferentes padrões de proliferação do epitélio odontogênico das lesões císticas odontogênicas de comportamento mais agressivo, através da analise da imunoexpessão do fator de crescimento epidérmico (EGFR) e da via de transcrição SOX 2 no controle das fases do ciclo celular (ciclina D1) em lesões odontogênicas de caráter agressivo. MATERIAIS E MÉTODOS: Estudo seccional com amostra não probabilística por conveniência composta por 31 casos, sendo 10 casos de ceratocistos odontogênicos recidivantes, 10 casos de ceratocistos odontogênicos (COs) isolados, 7 casos de cistos odontogênicos botrióides (COB) e 4 casos de cistos odontogênicos glandulares (COG). RESULTADOS: Ao analisar estatisticamente com os testes de Mann-Whitney e Kruskal-Wallis; P <0,05 foi considerado significativo. A maior expressão de células positivas para ciclina D1 foi observada na camada suprabasal de ceratocistos odontogênicos (P <0,001) e nas camadas basal e suprabasal dos COGs (P <0,001), e porções dos COBs (P>0,001). Não houve diferença estatística entre os COs recorrente e não recorrentes. Além disso, todos os casos de COs, COBs e COGs foram positivos para EGFR em todas as camadas do revestimento epitelial cístico. Os COBs e COGs apresentaram negatividade para o SOX 2 enquanto que nos COs foram encontrados alta expressão de SOX 2 na camada suprabasal. CONCLUSÕES: A ciclina D1 implica nos distúrbios do ciclo celular nas fases G1-S refletindo na agressividade dos COs e COGs. A superexpressão do EGFR demonstrada nos COs, COBs e COGs sugere que a combinação citoplasmática e citoplasmática membranosa é indicativo do potencial de proliferação do revestimento epitelial. O alto padrão da expressão do SOX 2 no CO também pode explicar a natureza agressiva da lesão e são responsáveis pela presença de numerosos cistos-filhos responsáveis por sua alta taxa de recorrência. A subpopulação de CSC se apresenta como motivo de recorrência aos COs, pela propriedade de auto-renovação e pluripotência destas células (AU).

INTRODUCTION: Odontogenic cysts are known for their growth potential and bone resorption of gnathic bones, ranging from indolent to aggressive, regardless of their histogenesis, linked to the epithelial, ectomesenchymal and / or mesenchymal remnants of odontogenesis. Most of these lesions have controversial pathogenesis, which is why they stimulate numerous investigations on the possible relationship between the odontogenic epithelium and the development of these lesions. OBJECTIVE: To analyze the different patterns of proliferation of odontogenic epithelium in odontogenic cystic lesions with more aggressive behavior, through the analysis of the epidermal growth factor (EGFR) immunoexpression and the SOX 2 transcription pathway in the control of the cell cycle phases (cyclin D1 ) in aggressive odontogenic lesions. MATERIALS AND METHODS: Sectional study with a non-probabilistic sample for convenience consisting of 31 cases, 10 cases of recurrent odontogenic keratocysts (COs) isolated, 10 cases of botryoid odontogenic cysts (BOC) and 4 cases of odontogenic cysts glandular (COG). RESULTS: When analyzing statistically with the Mann-Whitney and Kruskal-Wallis tests; P <0.05 was considered significant. The highest expression of positive cells for cyclin D1 was observed in the suprabasal layer of odontogenic keratocysts (P <0.001) and in the basal and suprabasal layers of COGs (P <0.001), and portions of COBs (P> 0.001). There was no statistical difference between recurrent and non-recurring COs. In addition, all cases of COs, COBs and COGs were positive for EGFR in all layers of the cystic epithelial lining. COBs and COGs showed negativity for SOX 2 while COs found high expression of SOX 2 in the suprabasal layer. CONCLUSIONS: Cyclin D1 implies cell cycle disorders in G1-S phases, reflecting the aggressiveness of COs and COGs. The overexpression of EGFR demonstrated in COs, COBs and COGs suggests that the combination of cytoplasmic and membranous cytoplasmic is indicative of the proliferation potential of the epithelial lining. The high standard of SOX 2 expression in CO can also explain the aggressive nature of the lesion and are responsible for the presence of numerous child cysts responsible for its high rate of recurrence. The CSC subpopulation presents itself as a reason for recurrence to COs, due to the self-renewal and pluripotency properties of these cells (AU).