Drug-induced sarcoidosis-like reaction to adalimumab in the oral mucosa of a patient with Crohn's Disease.

BACKGROUND: The drug-induced sarcoidosis-like reaction (DISR) is a condition clinically and pathologically similar to sarcoidosis but is induced by certain drugs. A few cases of DISR associated with the use of TNF-α antagonists have been reported in the literature. CASE REPORT: A 49-year-old female patient with a diagnosis of Crohn's Disease under treatment with adalimumab presented with a 2-month-long ulcerated swelling in the left lower fornix. Histological analysis of the biopsy specimen revealed multiple non-caseating granulomas multinucleated cells and epithelioid macrophages surrounded by lymphocytes. The lesion is under symptomatic control with a topical corticosteroid, and the patient is being monitored for manifestation in other organs and systems. CONCLUSION: Lesions of DISR may occur isolated in the oral mucosa. Therefore, this complication must be considered in the differential diagnosis of oral granulomatous lesions in patients under treatment with anti-TNF-α drugs.

Garlic burn trauma of the oral mucosa in a patient with trigeminal neuralgia: A case report.

Garlic is one of the most common medicinal plants used since ancient times to treat diverse diseases within several cultures worldwide. Nevertheless, this plant has the potential to cause chemical burns of the skin and mucosa. This report presents a case of a garlic burn in the palate of a 57-year-old woman who applied garlic to the palate to relieve the pain of trigeminal neuralgia. This case demonstrates the potential of garlic to cause chemical burns to the oral mucosa and raises an alert to oral health professionals regarding inappropriate self-treatment methods.

Fluorescence-guided surgical management of medication-related osteonecrosis of the jaws.

Medication-related osteonecrosis of the jaw (MRONJ) results in progressive destruction of the jawbones, and advanced cases demand surgical intervention. The total removal of necrotic bone is required to prevent recurrence and infection. However, determining the limits between necrotic and healthy bone is a challenge. The use of fluorescence to detect tissue alterations and determine necrosis extension is a promising method to avoid inadequate bone debridement. In the literature, there are several studies and reported cases that successfully use fluorescence-guided surgery (FGS) of MRONJ. The objective of this study was to present a critical review of the literature regarding the intraoperative use of optic fluorescence to differentiate healthy and necrotic bone in MRONJ. Studies that evaluated the intraoperative use of optic fluorescence to determine the surgical margins of MRONJ were searched in Pubmed/Medline and Scopus databases using the following terms: "medication-related osteonecrosis of the jaws" and "fluorescence". Eighteen papers describing the intraoperative use of FGS in ONJ management were selected, totalizing 218 patients. Of those 18 papers, only 5 were prospective studies, and the other 13 were isolated case reports, case series, and technical notes. The use of FGS to delimitate the resection margin of MRONJ is a promising method. There is no need for the application of exogenous fluorophore to perform FGS and the most often used light device was the VELScope® system. Further prospective studies with larger samples are still required to ascertain the fluorescence validity as a supporting method in MRONJ surgical treatment and to establish clinical protocols.

History and future perspectives for the use of fluorescence visualization to detect oral squamous cell carcinoma and oral potentially malignant disorders.

The early diagnosis of oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) is challenging. The use of fluorescence visualization (FV) has been improved as an auxiliary method to early detect alterations in the oral mucosa suggestive of malignancy or pre-malignancy. However, perhaps due to some misinterpretation regarding the clinical purpose of this method, its applicability may have been underestimated. The purpose of this review is to comment on the challenges within the prevention and early diagnosis of OSCC and OPMDs; to contextualize the use of fluorescence-based methods in the diagnosis of human cancers; and to critically analyze the methods and results of studies that evaluated the FV to detect OSCC and OPMDs, and how this method might be applicable in the clinical practice. The current evidence available in the scientific literature indicates that the FV has the potential to improve the early detection of OSCC and OPMDs. Its use in primary healthcare by general practice dentists, oral hygienists, and oral health therapists is recommended, although more research in the population screening scenario is still required.

Diagnosis and treatment of oral lichen sclerosus in a pediatric patient.

Lichen sclerosus is an uncommon chronic inflammatory disease, which rarely affects the oral mucosa. Here, we describe the occurrence of oral lichen sclerosus with gingival destruction in a 12-year-old female patient. After diagnostic confirmation by histopathology, intralesional injection of corticosteroid was performed, producing satisfactory remission of the lesion.

Fluorescence visualization improves the detection of oral, potentially malignant, disorders in population screening.

BACKGROUND: Scientific literature shows the great potential of fluorescence visualization (FV) in the detection of lesions in the skin and mucosa, though its use has been intermitant. Thus, the aim of this study was to compare the detection of oral cancer and oral potentially malignant disorders (OPMD) with and without the use of fluorescence visualization in population screening. PATIENTS AND METHODS: During a population screening for oral cancer and OPMD, general practice dentists (GPD) performed conventional oral examination (COE) in the first year, and in the second year the FV was inserted in the oral examination. When detecting any suspicious lesion in oral mucosa either by COE or FV, patients were referred for final diagnosis by a specialist in oral medicine. Biopsy was performed in cases of high-risk lesions to confirm the diagnosis, presence of epithelial d (ED), and oral squamous cell carcinoma (OSCC). RESULTS: During the oral cancer prevention campaign in the first year, benign neoplasms were the oral lesions with higher diagnosis rate (26.2%), followed by non-neoplastic proliferative processes (23.8%) and potentially malignant disorders (21.4%). During the second year, with the implementation of the use of FV, OPMD were the lesions with higher diagnosis rate (37.7%). The sensitivity, specificity and accuracy for the detection of potentially malignant disorders were respectively equal to 94.4%, 96.2% and 96.1%. The detection of lesions with epithelial dysplasia for these amounts were respectively equal to 100%, 92.4% and 92.6%. CONCLUSION: FV presented high diagnostic values when used by GPD and improved the detection of OPMD in population screening. FV has potential to be used as an adjunctive method for early diagnosis of oral high-risk lesions.

Cirurgia parendodôntica como opção para casos especiais: relato de caso / Parendodonic surgery as an option for special cases: case story / Cirugía parendodóntica como opción para casos especiales: relato de caso

A terapia endodôntica consiste em: abertura coronária, modelagem, limpeza, desinfecção, e selamento tridimensional do sistema de canais radiculares. Dentre as etapas constituintes do tratamento, a análise da anatomia interna dos dentes a serem tratados, deve ser cuidadosamente observada e seguir os princípios científicos e biológicos para que sejam minimizadas as possibilidades de falhas e acidentes. Os erros podem ocorrer tanto pela falta de habilidade do profissional, anatomia do elemento a ser tratado ou característica dos instrumentos. Em casos onde há dentes com lesão periapical, por conta de canais calcificados ou obstruídos por instrumentos fraturados, falha do tratamento convencional e impossibilidade de retratamento, é indicada a cirurgia paraendodôntica como opção de tratamento. O objetivo do presente estudo é descrever um relato de caso clínico sobre cirurgia paraendodôntica como tratamento para lesão periapical e manobra cirúrgica para remoção de um instrumento fraturado no terço apical do dente 22. Conclusão: quando o tratamento por via convencional é impossível de ser realizado, a cirurgia paraendodôntica é uma ótima opção de tratamento para dentes com lesões periapicais e para remoção de instrumentos fraturados, sendo uma forma de preservar o órgão dental e evitar extrações preciptadas. No presente estudo foi possível notar radiograficamente a regressão da lesão periapical e clinicamente a ausência de sintomatologia(AU)

The endodontic therapy consists of: coronary opening, modeling, cleaning, disinfection, and three-dimensional sealing of the root canal system. Between the constituent stages of the treatment, the analysis of the internal anatomy of the teeth to be treated, must be carefully observed and follow the scientific and biological principles to minimize the chances of faults and accidents. Errors can occur due to lack of skill of the professional, anatomy of the element to be treated or characteristic of the instruments. In cases where there are teeth with periapical lesions, due to calcified or obstructed channels by fractured instruments, failure of conventional treatment and impossibility of retreatment, paraendodonic surgery is indicated as an option for treatment. The aim of the present study is to describe a clinical case report on para-endodontic surgery as a treatment for periapical injury and surgical maneuver for the removal of a fractured instrument in the apical third of tooth 22. Conclusion: when conventional treatment is impossible to perform, Para-endodontic surgery is an optimal treatment option for teeth with periapical lesions and for the removal of fractured instruments, being a way to preserve the dental organ and avoid precipitated extractions. In the present study it was possible to observe radiographically the regression of the periapical lesion and clinically the absence of symptomatology(AU)

La terapia endodóntica consiste en: apertura coronaria, modelado, limpieza, desinfección, y sellado tridimensional del sistema de canales radiculares. Entre las etapas constituyentes del tratamiento, el análisis de la anatomía interna de los dientes a tratar, debe ser cuidadosamente observado y seguir los principios científicos y biológicos para minimizar las posibilidades de fallas y accidentes. Los errores pueden ocurrir tanto por la falta de habilidad del profesional, anatomía del elemento a ser tratado o característica de los instrumentos. En casos donde hay dientes con lesión periapical, debido a canales calcificados u obstruidos por instrumentos fracturados, falla del tratamiento convencional y imposibilidad de retratamiento, se indica la cirugía paraendodónica como opción de tratamiento. El objetivo del presente estudio es describir un relato de caso clínico sobre cirugía paraendodóntica como tratamiento para lesión periapical y maniobra quirúrgica para remoción de un instrumento fracturado en el tercio apical del diente 22. Conclusión: cuando el tratamiento por vía convencional es imposible de realizar, la cirugía paraendodóntica es una óptima opción de tratamiento para dientes con lesiones periapicales y para remoción de instrumentos fracturados, siendo una forma de preservar el órgano dental y evitar extracciones precipitadas. En el presente estudio fue posible observar radiográficamente la regresión de la lesión periapical y clínicamente la ausencia de sintomatologia(AU)

The performance of digital microscopy for primary diagnosis in human pathology: a systematic review.

Validation studies of whole slide imaging (WSI) systems produce evidence regarding digital microscopy (DM). This systematic review aimed to provide information about the performance of WSI devices by evaluating intraobserver agreement reported in previously published studies as the best evidence to elucidate whether DM is reliable for primary diagnostic purposes. In addition, this review delineates the reasons for the occurrence of discordant diagnoses. Scopus, MEDLINE/PubMed, and Embase were searched electronically. A total of 13 articles were included. The total sample of 2145 had a majority of 695 (32.4%) cases from dermatopathology, followed by 200 (9.3%) cases from gastrointestinal pathology. Intraobserver agreements showed an excellent concordance, with values ranging from 87% to 98.3% (κ coefficient range 0.8-0.98). Ten studies (77%) reported a total of 128 disagreements. The remaining three studies (23%) did not report the exact number and nature of disagreements. Borderline/challenging cases were the most frequently reported reason for disagreements (53.8%). Six authors reported limitations of the equipment and/or limited image resolution as reasons for the discordant diagnoses. Within these articles, the reported pitfalls were as follows: difficulties in the identification of eosinophilic granular bodies in brain biopsies; eosinophils and nucleated red blood cells; and mitotic figures, nuclear details, and chromatin patterns in neuropathology specimens. The lack of image clarity was reported to be associated with difficulties in the identification of microorganisms (e.g., Candida albicans, Helicobacter pylori, and Giardia lamblia). However, authors stated that the intraobserver variances do not derive from technical limitations of WSI. A lack of clinical information was reported by four authors as a source for disagreements. Two studies (15.4%) reported poor quality of the biopsies, specifically small size of the biopsy material or inadequate routine laboratory processes as reasons for disagreements. One author (7.7%) indicated the lack of immunohistochemistry and special stains as a source for discordance. Furthermore, nine studies (69.2%) did not consider the performance of the digital method-limitations of the equipment, insufficient magnification/limited image resolution-as reasons for disagreements. To summarize the pitfalls of digital pathology practice and better address the root cause of the diagnostic discordance, we suggest a Categorization for Digital Pathology Discrepancies to be used in further validations studies. Among 99 discordances, only 37 (37.3%) had preferred diagnosis rendered by means of WSI. The risk of bias and applicability concerns were judged with the QUADAS-2. Two studies (15.4%) presented an unclear risk of bias in the sample selection domain and 2 (15.4%) presented a high risk of bias in the index test domain. Regarding applicability, all studies included were classified as a low concern in all domains. The included studies were optimally designed to validate WSI for general clinical use, providing evidence with confidence. In general, this systematic review showed a high concordance between diagnoses achieved by using WSI and conventional light microscope (CLM), summarizes difficulties related to specific findings of certain areas of pathology-including dermatopathology, pediatric pathology, neuropathology, and gastrointestinal pathology-and demonstrated that WSI can be used to render primary diagnoses in several subspecialties of human pathology.

Oral lesions detected during a population screening for prevention and early diagnosis of oral cancer and potentially malignant disorders / Lesões orais detectadas durante uma triagem populacional para prevenção e diagnóstico precoce de câncer de boca e lesões potencialmente maligniziveis

Objective: In this paper, we describe the results of an oral cancer prevention campaign for early detecting and diagnosing oral cancer and potentially malignant disorder. Subjects and method: The population screening was performed in one day in which population was recruited by local mass media communication means. Patients with suspicious lesions were referred for final diagnosis with a specialist in oral medicine and pathology. Results: Of 1.282 patients screened, 104 were referred for specialized care and 94 attended for final diagnosis. Of those, only one (1.06%) patient was diagnosed with oral squamous cell carcinoma and 25 (26.5%) with oral potentially malignant disorders, while the diagnosis rates for benign conditions and normality variations were, respectively, 78.7% and 32.9%. Conclusion: These results suggest low awareness regarding oral cancer within this population, flaws in the knowledge regarding oral cancer by dentists, and the need for improvements in the access to the at-risk population for oral cancer.(AU)

Objetivo: neste artigo, descrevemos os resultados de uma campanha de prevenção do câncer de boca para detectar e diagnosticar precocemente câncer de boca e lesões bucais potencialmente maligniziveis. Sujeitos e método: uma triagem populacional foi realizada em um dia em que a população foi recrutada por meios de comunicação de mídia local. Pacientes com lesões suspeitas foram encaminhados para diagnóstico final com especialista em Estomatologia e Patologia Bucal. Resultados: dos 1.282 pacientes selecionados, 104 foram encaminhados para atendimento especializado e 94 atendidos para diagnóstico final. Desses, apenas um (1,06%) paciente foi diagnosticado com carcinoma espinocelular de boca e 25 (26,5%) com lesões bucais potencialmente maligniziveis, enquanto as taxas de diagnóstico para condições benignas e variações de normalidade foram, respectivamente, 78,7% e 32,9%. Conclusão: esses resultados sugerem baixa conscientização sobre o câncer bucal nessa população, falta conhecimento sobre o câncer bucal por dentistas e a necessidade de melhorias no acesso à população em risco de câncer bucal.(AU)

Fluorescência óptica no diagnóstico de lesões em colo cervical: revisão de literatura / Optical fluorescence in the diagnosis of cervical colosion injuries: literature review / Fluorescencia óptica en el diagnóstico de lesiones en colo cervical: revisión de literatura

O câncer de colo uterino ainda hoje é um problema de saúde pública em muitas partes do mundo. No Brasil, é o terceiro tumor maligno mais frequente entre as mulheres. Uma das causas pontadas como percussor desse câncer é o HPV, principalmente, quando correlacionado a outros fatores de riscos e estilo de vida. Sua cura é altamente possível desde que se tenha um diagnóstico rápido e preciso. Na maioria dos casos, as alterações celulares no colo uterino são descobertas facilmente no exame preventivo conhecido como Papanicolau. Outro método que pode ser utilizado para esta detecção precoce de lesões em colo cervical é a fluorescência óptica que não é invasivo e vem sendo amplamente utilizado no diagnóstico de lesões bucais e de pele. Dessa forma, o presente trabalho teve como objetivo realizar uma revisão da literatura sobre a aplicação da fluorescência óptica no diagnóstico de lesões em colo cervical(AU)

Cervical cancer is still a public health problem in many parts of the world today. In Brazil, it is the third most frequent malignant tumor among women. One of the leading causes of this cancer is HPV, especially when correlated with other risk factors and lifestyle. Its cure is highly possible as long as you have a quick and accurate diagnosis. In most cases, cellular changes in the cervix are easily discovered in the preventive examination known as Papanicolaou. Another method that can be used for this early detection of cervical lesions is non-invasive optical fluorescence and has been widely used in the diagnosis of oral and skin lesions. Thus, the present work had the objective of reviewing the literature on the application of optical fluorescence in the diagnosis of cervical lesions(AU)

El cáncer de cuello uterino sigue siendo un problema de salud pública en muchas partes del mundo. En Brasil, es el tercer tumor maligno más frecuente entre las mujeres. Una de las causas planteadas como percusión de este cáncer es el VPH, principalmente, cuando está correlacionado con otros factores de riesgo y estilo de vida. Su curación es altamente posible desde que se tenga un diagnóstico rápido y preciso. En la mayoría de los casos, los cambios celulares en el cuello uterino se descubren fácilmente en el examen preventivo conocido como Papanicolaou. Otro método que puede ser utilizado para esta detección precoz de lesiones en cuello cervical es la fluorescencia óptica que no es invasiva y viene siendo ampliamente utilizado en el diagnóstico de lesiones bucales y de piel. De esta forma, el presente trabajo tuvo como objetivo realizar una revisión de la literatura sobre la aplicación de la fluorescencia óptica en el diagnóstico de lesiones en cuello cervical(AU)

Cisto dentígero: diagnóstico e tratamento / Cisto dentígero: diagnosis and treatment / Cisto dentígero: diagnóstico y tratamiento

O cisto dentígero é um cisto odontogênico que é classificado como de desenvolvimento. Normalmente, está relacionado à coroa de um dente incluso, sendo um dos cistos odontogênicos mais frequentes nos ossos gnáticos. Na maioria das vezes é diagnosticado em pacientes entre a segunda e a terceira década de vida, com grande ocorrência em terceiros molares inferiores e caninos superiores. Clinicamente, apresenta evolução lenta, assintomática e pode causar discreta deformidade facial, deslocamento de dentes e alterações de estruturas na região. Radiograficamente, os cistos dentígeros são descritos como lesões radiolúcidas bem delimitadas e uniloculares. Na maioria dos casos, são observados em exames de rotina ou durante a pesquisa da causa da não erupção de um dente permanente. Apesar da singularidade clínica de cada caso, o prognóstico dessa lesão é favorável. O tratamento para o cisto dentígero pode ser a marsupialização em casos de lesões grandes, enucleação com exodontia do dente incluso ou preservação do elemento dental. Este trabalho visa apresentar um caso clínico de cisto dentígero em região posterior de mandíbula, abordando aspectos clínicos, imaginológicos, histopatológicos e terapêuticos, com a finalidade de familiarizar o cirurgião dentista com tal lesão(AU)

The dentigerous cyst is an odontogenic cyst that is classified as developmental cyst. It is usually related to the crown of an included tooth, being one of the most frequent odontogenic cysts in the gnatic bones. Most of the time it is diagnosed in patients between the second and third decade of life, with great occurrence in third molars and upper canines. Clinically, it presents slow evolution, asymptomatic and can cause discreet facial deformity, tooth dislocation and alterations of structures in the region. Radiographically, dentigerous cysts are described as well delimited and unilocular radiolucent lesions. Normally, they are seen in routine examinations or during the investigation of the cause of non-eruption of a permanent tooth. Despite the clinical singularity of each case, the prognosis of this lesion is favorable. The treatment for dentigerous cyst may be marsupialization in cases of large lesions, enucleation with exodontia of the included tooth or preservation of the dental element. This paper aims to present a case report of a dentigerous cyst in the mandible, posterior region, addressing clinical, imaging, histopathological and therapeutic aspects, in order to familiarize the dentist surgeon with such lesion(AU)

El quiste dentígero es un quiste odontogénico que se clasifica como de desarrollo. Normalmente, esta relacionada con la corona de un diente incluido, siendo uno de los quistes odontogénicos más frecuentes en los huesos gnáticos. La mayoría de las veces se diagnostica en pacientes entre la segunda y la tercera década de vida, con gran ocurrencia en terceros molares inferiores y caninos superiores. Clínicamente, presenta evolución lenta, asintomática y puede causar discreta deformidad facial, desplazamiento de dientes y cambios de estructuras en la región. Los cistos dentígeros se describen como lesiones radiolúcidas bien delimitadas y uniloculares. Normalmente, se observan en exámenes de rutina o durante la investigación de la causa de la no erupción de un diente permanente. A pesar de la singularidad clínica de cada caso, el pronóstico de esta lesión es favorable. El tratamiento para el quiste dentígero puede ser la marsupialización en casos de lesiones grandes, enucleación con exodoncia del diente incluido o preservación del elemento dental. Este trabajo pretende presentar un relato de caso clínico de quiste dentígero en mandíbula, región posterior, abordando aspectos clínicos, imaginológicos, histopatológicos y terapéuticos, con la finalidad de familiarizar al cirujano dentista con tal lesión(AU)

Radiation-related superficial oral mucoceles: An under-recognized acute toxicity in head and neck cancer patients

BACKGROUND: Acute toxicity is usually defined as adverse changes occurring immediately or a short time after the start of oncological treatment. Material an METHODS: Cross-sectional retrospective study performed with head and neck cancer patients who underwent radiotherapy from 2013 to 2016. RESULTS: Ten (1.2%) patients developed SOMs during radiotherapy, most (80%) of which were men with a mean age of 59.5 years at diagnosis. SOMs mainly affected the floor of the mouth (60%) between the fourth and the sixth weeks of radiation therapy. All lesions were asymptomatic and spontaneously ruptured approximately 9 days after diagnosis. CONCLUSIONS: Although rare, SOMs may be regarded as an acute oral toxicity of head and neck radiotherapy

Tongue metastasis of cutaneous melanoma: Report of two cases and literature review.

INTRODUCTION: Malignant metastases to the oral cavity are rare and metastatic melanomas of the tongue are considered exceptionally uncommon, with less than 10 cases published in the English literature so far. CASE REPORTS: Two female patients in the 7th decade of life presented to our dental service with nodules in the tongue. Both patients had multiple metastases at the time of oral diagnosis and primary melanoma originated on the skin. An intra-oral incisional biopsy was performed under local anesthesia and the histopathologic analysis was characterized by the proliferation of atypical epithelioid cells displaying a poorly delimited cytoplasm and hyperchromatic nucleus which contained eosinophilic macronucleoli. Immunohistochemistry was performed in both cases to confirm the clinical hypothesis of metastatic melanoma. After the diagnosis of oral metastatic melanoma, the patients were maintained under palliative care and close medical follow-up. Both patients died four and a half months and 20 months after the diagnosis of tongue metastasis. CONCLUSIONS: Although rare, metastatic melanoma should be included in the differential diagnosis of tongue lesions detected in patients with a previous medical history of cutaneous melanoma. Key words:Melanoma, tongue, metástases.

Uncommon Occurrence of Lip Squamous Cell Carcinoma in a Pediatric Patient.

Although head and neck squamous cell carcinoma represents one of the most common cancers among adults, it is rare in pediatric patients. The purpose of this report is to discuss the case of a 15-year-old male patient referred by his dentist due to a three-month old ulcer in his lower lip. The patient denied tobacco smoking and drinking alcohol, and confirmed that he performed manual labor in a brick yard, being exposed daily to the sun without protection. Clinical examination revealed an exophytic rounded ulcer in the right lower lip, measuring 1.5 cm, with a flaky bed. An incisional biopsy was performed, and histopathologic analysis confirmed the diagnosis of squamous cell carcinoma. The treatment of choice was surgical excision. Malignancy should be included in the differential diagnosis of chronic oral ulcers in children and adolescents. Moreover, chronic sun exposure might be associated with occurrence of lip squamous cell carcinoma.