Intratarsal Keratinous Cyst Clinically Misdiagnosed as a Chalazion.

The intratarsal keratinous cyst (IKC) is a recently described entity, often clinically misdiagnosed as a chalazion. We report a case of a 61-year-old male patient with a chief complaint of a small lesion on the upper eyelid that evolved over six months. On physical examination, an asymptomatic, firm nodule was identified on the left upper eyelid. The patient reported no history of trauma. A provisional diagnosis of chalazion was established, and an excisional biopsy was performed. Histopathologically, the lesion was lined with a stratified squamous epithelium, with a corrugated epithelial surface showing abrupt keratinization without keratohyalin granules, and compact keratinous-appearing material in the cystic lumen. The diagnosis was IKC. No signs of recurrence were observed after one year of follow-up. It is essential to accurately diagnose IKC and distinguish it from chalazion and epidermal inclusion cysts, because IKC requires complete surgical excision and can exhibit multiple recurrences if not properly removed.

A retrospective multicenter study of oral and maxillofacial lesions in older people.

Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

Clinicopathologic analysis of oral dermoid and epidermoid cysts: a Brazilian multicenter study.

Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.

Diagnosis and management of exuberant palatal pyogenic granuloma in a systemically compromised patient - Case report.

AIM: To discuss the diagnosis and treatment of an exuberant oral pyogenic granuloma (OPG) in the palatal region in a systemically compromised patient. METHODS AND RESULTS: A 50-year-old woman presented with extensive and painless nodular mass that extended throughout the palatal region, with difficulty speaking, swallowing and spontaneous bleeding for 6 months. Her medical history showed poorly controlled type II diabetes mellitus and hypertension. The intraoral physical examination also revealed poor oral hygiene and periodontal disease. After clinical and radiographic evaluation, the presumptive diagnosis of OPG was made and complete excision of the lesion was performed. Local hemostatic measures were employed to control bleeding. Microscopic evaluation showed a lobulated lesion composed of many blood capillaries confirming the diagnostic hypothesis. CONCLUSIONS: In summary, individuals with severe periodontal disease and systemic disorders may present exacerbated clinical presentations of OPG.

Maxillary Surgical Ciliated Cyst After Orthognathic Surgery.

Surgical ciliated cysts, also known as implantation cysts or postoperative maxillary cysts, are uncommon cystic formations predominantly arising in the posterior maxillary region after radical maxillary sinus surgery. Herein, we present the case of a 28-year-old male patient who had previously undergone orthognathic surgery and later experienced a minor car accident without major consequences. Approximately four years after surgery, the patient sought dental care due to the presence of a painless swelling in the maxillary region. Upon intraoral examination, the swelling extended from the area around the right canine to the upper left molar, covered by red mucosa. Image studies revealed an extensive well-defined osteolytic lesion causing thinning, erosion, buccal cortical plate perforation, and root resorption. An incisional biopsy was performed, and microscopic examination revealed a cystic lesion lined by ciliated respiratory-type epithelium and capsule variably fibrotic with sparse chronic inflammation. The final diagnosis was surgical ciliated cysts. The treatment approach involved decompression followed by enucleation and curettage, with the addition of bone grafting and the application of Leukocyte-Platelet Rich Fibrin (L-PRF). The patient has been under clinical follow-up for approximately 17 months with no signs of recurrence. A careful morphological evaluation is essential to avoid misdiagnosis and ensure a satisfactory treatment approach. In conclusion, this case highlights the importance of accurate diagnosis and appropriate treatment approaches for surgical ciliated cysts to ensure favorable patient outcomes.

A destructive sinonasal organizing hematoma mimicking malignancy.

Sinonasal organizing hematomas (SOH) are rare, benign lesions that can be mistaken for malignancies due to their unfamiliarity among clinicians and aggressive appearance on imaging, which can lead to aggressive and unnecessary therapeutic interventions. Herein, we report an unusual case of SOH in an 87-year-old female patient who sought care at a maxillofacial surgery service due to persistent right nasal obstruction and imaging findings that suggested the possibility of sinonasal malignancy. We highlight the importance of recognizing these lesions to ensure adequate treatment through a conservative approach.

Basal cell adenocarcinoma of the soft palate: A closer look for an exceedingly rare salivary gland tumor.

Basal cell adenocarcinoma (BCAd) is an extremely rare primary biphasic carcinoma of the salivary glands with few well-documented cases reported in the literature. Herein, we report a rare case of a 44-year-old male patient who presented an oral medicine service with an erythematous nodular lesion on the soft palate, measuring 1.5 cm in its largest diameter, with a 5-year duration. The clinical diagnosis was pleomorphic adenoma, and an excisional biopsy was performed. Histopathological analysis revealed a biphasic infiltrative tumor composed of a mixture of central ductal cells and abluminal basal cells with slight atypia arranged in solid, trabecular, tubular and cribriform growth patterns in a loose stroma. The peripheral cells show a palisading arrangement with round hyperchromatic nuclei and scanty cytoplasm. Occasional mitotic figures were seen. Few spindle-shaped cells suggestive of myoepithelial cells were present in the stroma surrounding the basaloid tumor nests. The diagnosis was BCAd. The patient was referred to a head and neck service and has been followed up for 8 months with no signs of recurrence. In conclusion, although the diagnosis of BCAd can be challenging due to its rarity and morphological overlap with other salivary gland lesions, a meticulous morphological assessment is key for accurate diagnosis, especially in cases originating from minor salivary glands. Surgical excision with a wide safety margin is the treatment of choice and long-term follow-up is recommended to monitor possible recurrences.

Squamous Odontogenic Tumor in the Posterior Region of Maxilla.

Squamous odontogenic tumor (SOT) is a rare benign but locally infiltrative tumor often misdiagnosed as other entities, such as ameloblastoma and squamous cell carcinoma, due to overlapping morphological findings. We document here the clinicopathological and imaging findings of an aggressive intraosseous SOT in the posterior left region of the maxilla in a 25-year-old male patient. On intraoral examination, the tumor extended from the region of the left lateral incisor to the upper left premolar and was covered by reddish mucosa, with discrete areas of ulceration. Imaging exams revealed an osteolytic lesion causing thinning, erosion, and buccal and lingual cortical plate perforation associated with an impacted canine. Microscopically, the tumor showed a proliferation of islands of well-differentiated squamous epithelium in a variably collagenized background. The peripheral cells of the islands were flat or slightly cuboidal and did not exhibit nuclei with peripheral palisade and reverse polarization. The diagnosis of SOT was rendered. The patient underwent surgical resection and has been under clinical follow-up for approximately 12 months with no signs of recurrence. A careful morphological evaluation is essential to avoid misdiagnosis and ensure a satisfactory treatment approach.

Oral solitary fibrous tumors: A collaborative clinicopathologic study of 19 cases.

OBJECTIVE: To report the clinicopathologic features of 19 oral solitary fibrous tumors (SFTs). METHODS: Clinical data were collected from the records of seven pathology services. All cases were re-evaluated by HE staining and confirmed by immunohistochemistry. RESULTS: The series comprised 11 females (57.9%) and 8 males (42.1%), with a mean age of 47.3 ± 14.7 years (range: 22-71 years) and a 1.3:1 female-to-male ratio. Most tumors affected the buccal mucosa (n = 7; 36.8%) and presented clinically as an asymptomatic solitary submucosal well-circumscribed nodule with coloration similar to the oral mucosa. Morphologically, most SFTs (n = 10; 52.6%) exhibited a classic hybrid pattern characterized by a well-circumscribed proliferation of densely cellular areas alternating with hypocellular areas in a variably collagenous vascular stroma. Remnants of accessory salivary glands were observed in two cases (n = 2; 10.5%). All tumors were positive for STAT6 and CD34 (n = 19; 100%). Outcome information was available from 6 patients (31.6%), with clinical follow-up ranging from 6 to 24 months (mean ± SD, 9.5 ± 6.8 months), and none developed local recurrence. CONCLUSIONS: Oral SFTs are rare and often clinically misdiagnosed. Pathologists should consider SFT in the differential diagnosis of oral spindle cell tumors. Accurate diagnosis requires careful morphological evaluation supported by immunohistochemical analysis.

A rare case of mucoepidermoid carcinoma ex-pleomorphic adenoma of the hard palate.

Carcinoma Ex-Pleomorphic Adenoma (CExPA) is a salivary gland carcinoma derived from a primary or recurrent benign pleomorphic adenoma (PA) extremely rare in minor salivary glands. In this paper, we report the case of a male afrodescendant patient, 37 years old, presenting a palatal irregular nodular lesion with approximately 3.5 cm diameter. The lesion had over two years of evolution, but started growing faster and presenting pain and ulceration in the last two months. The incisional biopsy revealed a typical pleomorphic adenoma with focal areas of nests of epidermoid and mucous cells, as well as microcyst formations, resembling the mucoepidermoid carcinoma (MEC). Immunohistochemical analysis revealed positivity for CK7, CK13, CK 14, p63 and Ki67 (about 30%), whereas α-SMA was restricted to the PA component. The diagnosis was CExPA (MEC-type). A discussion on the histopathological and immunohistochemical criteria for differential diagnosis of CExPA is provided in this work, hoping to contribute to a better knowledge and understanding of this rare malignant tumor. Key words:Salivary gland neoplasms, pleomorphic adenoma, adenocarcinoma, mucoepidermoid carcinoma, pathology, differential diagnosis.

Salivary gland tumors: A 13-year clinicopathologic retrospective study in a Brazilian northeast population.

Background: The present study aimed to evaluate the clinicopathologic features of salivary gland tumors (SGTs) in a Brazillian northeast population. Material and Methods: A retrospective descriptive cross-sectional study was performed (1995-2009). All cases of SGTs diagnosed in a private surgical pathology service in Brazil were reviewed, and clinicopathological data were collected. Results: A total of 23.258 histopathological records of biopsies were analyzed, and 174 cases were diagnosed as SGTs (0.7%). Of these, 117 (67.2%) were classified as benign, and 57 (32.8%) were malignant. The series comprised 89 females (51.1%) and 85 males (48.9%), with a mean age of 50.2 years (range: 3-96 years) and a roughly equal female-to-male ratio (1:1). Most tumors occurred in the parotid gland (n = 82, 47.1%), followed by the palate (n = 45, 25.9%), submandibular gland (n = 15, 8.6%). Pleomorphic adenoma (n = 83; 70.9%) and mucoepidermoid carcinoma (n = 19, 33.3%) were the most frequent benign and malignant tumors, respectively. After reevaluation of morphology and immunohistochemical analysis, seven tumors (4.0%) were reclassified following the current WHO Classification of the Head and Neck Tumors. Conclusions: The general features of SGT from the studied Brazilian population were similar to previously published reports in other countries. However, SGTs do not show any sex predilection. Although careful morphological analysis is the key to the correct diagnosis of these tumors, immunohistochemical analysis is essential to establish an accurate diagnosis in the face of challenging cases. Key words:Salivary gland tumors, epidemiology, head and neck pathology.

Lingual metastasis as the first presentation of clear cell renal cell carcinoma: Report of a rare case clinically mimicking a benign lesion.

Metastases in the oral cavity are rare and frequently associated with widespread disease and poor prognosis. Clear cell renal cell carcinoma (ccRCC) is the most common subtype of renal cell carcinoma (RCC), known for its propensity for metastatic spread. The diagnosis of oral metastases from ccRCC is challenging, especially when the patient has no history of primary neoplasm. Herein, we reported a rare metastatic ccRCC in a 58-year-old female presenting clinically as a painless nodule on the tongue mimicking a benign lesion. Microscopically, the tumor showed a proliferation of clear cells organized in nests with a predominantly lobular arrangement. The dense connective tissue stroma was highly vascularized, exhibiting some areas with a hyalinized aspect. Immunohistochemistry showed focal positivity for pan-cytokeratin AE1/AE3 and strong positivity for CK8, CK18, epithelial membrane antigen (EMA), vimentin, and CD10. S-100 protein, HMB-45, CK7, and CK20 were negative. The definitive diagnosis was metastatic ccRCC. The treatment was initiated with sunitinib. However, the disease progressed, and the patient was submitted to palliative care. Despite the low survival rate of patients with metastases, the clinician's experience in identifying an oral metastatic lesion may reveal undiagnosed primary tumors and provide better prognosis and survival rates.

Mucosal Leishmaniasis of the lip: Report of an Exuberant case in a Young man.

BACKGROUND: Leishmaniasis is a tropical disease caused by protozoan parasites of the genus Leishmania. Mucosal leishmaniasis has been described as secondary to the cutaneous form; however, isolated mucosal involvement can also occur. Specifically, mucosal leishmaniasis of the lip is poorly described and its diagnosis challenges clinicians. METHODS: We herein report a case of mucosal leishmaniasis affecting the lower lip without cutaneous involvement in a 20-year-old Venezuelan man. The patient had no relevant past medical history. Clinically, a mass-like lesion with ulcerations and crusts was observed. RESULTS: Microscopically, the lesion was composed of granulomatous inflammation along with macrophages containing intracytoplasmic inclusions similar to round-shaped Leishmania. The species Leishmania (Viannia) braziliensis was confirmed. Treatment with meglumine antimonate was effective. The lesion healed satisfactorily, and no side effects or recurrences were observed. CONCLUSION: Clinicians should be aware of isolated forms of mucosal leishmaniasis of the lip, even in cases where the cutaneous lesion is undetected or clinically manifests as self-limiting. Knowing the endemic areas in the scenario of the dynamics of the ecoepidemiology of leishmaniasis is also essential for surveillance and counselling of the population.