Microvascular density analysis and histological parameters of oral cancer progression.

OBJECTIVES: This study aimed to investigate the role of blood and lymphatic microvascular density in the progression of oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: The sample was composed of 54 cases of OSCC. The immunoexpression to anti-alpha-smooth muscle actin (α-SMA) and to anti-endoglin (CD105) was used to determine the microvessel density (MVD); anti-podoplanin (D2-40) was used to assess the lymphatic vessel density (LVD); vascular endothelial growth factor (VEGF) was evaluated in malignant cells. The histological differentiation, the worst pattern of invasion (WPOI), tumour thickness and tumour budding (TB) intensity were assessed using haematoxylin-eosin and anti-pan-cytokeratin (AE1/AE3). Patients' age and sex, TNM classification and follow-up time were collected from the medical records. RESULTS: MVD markers presented a similar pattern of expression in blood vessels. However, only α-SMA + MVD was significantly higher among women and in tumours ≤4 cm. LVD was lower in tumours with lymph node metastasis. Regarding the histological parameters, high TB intensity was associated with histological differentiation, advanced clinical stage, greater tumour thickness and reduced disease-free survival. No difference was found in VEGF. CONCLUSIONS: The decrease in OSCC LVD could be related to pathological node involvement, whereas high TB intensity could indicate OSCC progression and worse patient outcomes.

Acquired oral syphilis: A multicenter study of 339 patients from South America.

OBJECTIVE: To report the clinicopathologic features of acquired oral syphilis cases in South American countries. MATERIALS AND METHODS: Clinical data were retrospectively collected from the records of 18 oral diagnostic services in Argentina, Brazil, Chile, Colombia, Venezuela, Uruguay, and Peru. Serologies of nontreponemal and treponemal tests were used for diagnosis. RESULTS: The series comprised 339 cases of acquired oral syphilis. Secondary syphilis ranked as the most common stage (86.7%). Lesions were more frequent among males (58.0%) and young adults with a mean age of 33.3 years. Individuals aged 20-29 years were most affected (35.3%). The most commonly involved sites were the tongue (31.6%), lip/labial commissure (25.1%), and hard/soft palate (20.4%). Clinically, acquired oral syphilis usually presented as mucous patches (28.4%), papules (25.7%), and ulcers (18.1%). Skin manifestations occurred in 67.7% of individuals, while lymphadenopathy and fever were observed in 61.3% and 11.6% of all subjects, respectively. Most patients were treated with the benzathine penicillin G antibiotic. CONCLUSION: This report validates the spread of acquired oral syphilis infection among young adults in South America. Our directives include accessible diagnostic tools for proper disease screening, surveillance, and counselling of affected individuals, especially in low- and middle-income countries.

Cartilaginous choristoma on the lateral surface of the tongue: a case report.

A cartilaginous choristoma is a nonneoplastic nodular growth of histologically normal cartilage in an abnormal site. This report describes a case of a cartilaginous choristoma on the lateral surface of the tongue in a 65-year-old woman. The entire lesion was excised, and histologic examination revealed mature cartilaginous tissue surrounded by dense connective tissue. Choristomas are rare findings in the oral cavity, easily confused with proliferative processes or soft tissue neoplasms. Nevertheless, choristomas may be part of the differential diagnosis for lesions similar to the one described in this case report.

Prevalence of traumatic orofacial and dental injury in unidentified bodies-Data from a forensic medicine institute in Brazil.

BACKGROUND/AIM: Orofacial trauma and traumatic dental injuries (TDI) are serious public health problems due to their high prevalence, severe morbidity, high costs of treatment, and long-term sequelae. However, the extent of the problem may be underestimated since trauma analysis, from a forensic odontology perspective, is not widely represented in the scientific literature. The aim of this study was to investigate the occurrence of traumatic orofacial injuries (TOI) and TDI in unidentified bodies and their association with the cause of death. MATERIALS AND METHODS: A retrospective analysis was conducted of dental and autopsy reports of unidentified bodies admitted to the Institute of Forensic Medicine of Belo Horizonte (IFM-BH), Brazil, between 2015 and 2016. The final sample was made up of 536 bodies. Demographic data, the location where the body was found, cause of death, and the presence and type of orofacial trauma were collected. RESULTS: The mean of the estimated age of the bodies was 38 years and the median was 35 years. Most of the bodies were from males (87.5%) and were found downtown in the city of Belo Horizonte (60.4%). Violence was the most common cause of death (64%), generally by gunshot (48.7%). Bodies with an estimated age ≤35 years were eight times more likely to have died from violent causes. TOI was registered in 50.9% of the reports. TDI was observed in 10.8% of the bodies. Victims of violent death were seven times more likely to present TOI. Such association was not observed when the presence of TDI was considered. CONCLUSIONS: There is a positive association between TOI and violent death in unidentified bodies.

Recurrent peripheral ameloblastoma in an elderly patient: A case report.

OBJECTIVE: To report a case of recurrent peripheral ameloblastoma (PA) in an elderly patient. BACKGROUND: PA is a benign tumour that affects soft tissues of gingiva or edentulous alveolar areas, exhibiting histopathological characteristics of ameloblastoma. METHODS: A 79-year-old man showed a nodule in the edentulous right mandibular alveolar ridge diagnosed as recurrent PA. CONCLUSION: Clinicians should consider PA as a differential diagnosis of routine nodular lesions affecting the oral mucosa of geriatric patients.

Cell proliferation is associated with intensity of tumor budding in oral squamous cell carcinoma.

BACKGROUND: Tumor budding is a morphological marker of cancer invasion, defined as the presence of isolated or small clusters of neoplastic cells at the tumor invasive front. This study aimed to evaluate the association between intensity of tumor budding and cell proliferation in oral squamous cell carcinoma (OSCC). METHODS: Immunohistochemistry was employed in 163 OSCC samples to detect the cell proliferation marker Ki-67 and multicytokeratin (to identify OSCC cells in tumor budding evaluation). The Mann-Whitney test was used to evaluate differences in the cell proliferation index between samples with high-intensity tumor budding and samples with low-intensity or no tumor budding. In samples with high-intensity tumor budding, the Wilcoxon test was used to evaluate differences in the cell proliferation index between the budding area and the area outside the budding. The chi-square test assessed the association between cell proliferation index and intensity of tumor budding. RESULTS: The cell proliferation index was higher in samples with high-intensity tumor budding than in samples with low-intensity or no tumor budding (P < .05). Tumors with high-intensity tumor budding showed a higher cell proliferation index in the budding area than in the area outside the budding (P < .05). Finally, samples showing high-intensity tumor budding were associated with high cell proliferation index (P < .05). CONCLUSION: Cell proliferation is positively associated with intensity of tumor budding in OSCC. Moreover, in tumors showing high-intensity tumor budding, the budding area is the location of higher cell proliferation. These findings reinforce the hypothesis that tumor budding is associated with the biological behavior of OSCC.

Reproducibility, repeatability, and level of difficulty of two methods for tumor budding evaluation in oral squamous cell carcinoma.

BACKGROUND: This study aimed to analyze the reproducibility, repeatability, and level of difficulty of two methods for tumor budding evaluation in oral squamous cell carcinoma (OSCC): staining by hematoxylin and eosin (HE) and immunostaining for multicytokeratin. METHODS: The evaluation of tumor budding was performed by three examiners in 103 samples of OSCC, using the two methods. A Likert-type scale was used to measure the difficulty in the assessment. The interexaminer agreement (reproducibility) was estimated using Fleiss's kappa and the intra-examiner agreement (repeatability) was estimated using Cohen's kappa. The agreement between the two methods was evaluated using Cohen's Kappa. The Friedman test was used to compare the three examiners' perceived levels of difficulty of assessment. The Wilcoxon test was used to compare the level of difficulty of the evaluation between the two methods. RESULTS: Reproducibility by the immunostaining method for multicytokeratin was substantial, being higher than the only fair agreement by the HE. Repeatability by the HE ranged from moderate to substantial among examiners, regardless of the examiner's experience. Repeatability by the immunostaining method for multicytokeratin did not vary among examiners, showing almost perfect agreement. The agreement between the two methods ranged from fair to moderate among examiners, being lower in the less experienced examiner. All the examiners presented greater difficulty in the evaluation by the HE. CONCLUSION: In view of the unsatisfactory agreement between the two methods of tumor budding evaluation in OSCC, it is recommended that this evaluation should be performed by the immunostaining method for multicytokeratin, considering its higher reproducibility, greater replicability, and lower difficulty compared to the HE.

Vertical augmentation of the posterior atrophic mandible by interpositional grafts in a split-mouth design: a human tomography evaluation pilot study.

OBJECTIVE: Using computed tomography, to compare vertical and volumetric bone augmentation after interposition grafting with bovine bone mineral matrix (GEISTLICH BIO-OSS® ) or hydroxyapatite/tricalcium phosphate (STRAUMANN® BONECERAMIC) for atrophic posterior mandible reconstruction through segmental osteotomy. MATERIAL AND METHODS: Seven patients received interposition grafts in the posterior mandible for implant rehabilitation. The computed tomography cone beam images were analysed with OsiriX Imaging Software 6.5 (Pixmeo Geneva, Switzerland) in the pre-surgical period (T0), at 15 days post-surgery (T1) and at 180 days post-surgery (T2). The tomographic analysis was performed by a single trained and calibrated radiologist. Descriptive statistics and nonparametric methods were used to analyse the data. RESULTS: There was a significant difference in vertical and volume augmentation with both biomaterials using the technique (P < 0.05). There were no significant differences (P > 0.05) in volume change of the graft, bone volume augmentation, or augmentation of the maximum linear vertical distance between the two analysed biomaterials. CONCLUSIONS: The GEISTLICH BIO-OSS® and STRAUMANN® BONECERAMIC interposition grafts exhibited similar and sufficient dimensional stability and volume gain for short implants in the atrophic posterior mandible.

Laminin-5 gamma 2 chain expression is associated with intensity of tumor budding and density of stromal myofibroblasts in oral squamous cell carcinoma.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is one of the most prevalent cancers worldwide. Laminin-5 gamma 2 chain (laminin-5 γ2) is a protein associated to a migratory phenotype in epithelial neoplastic cells. Stromal myofibroblasts also play a significant role in tumor invasion, due to its ability to modify the extracellular matrix. Tumor budding is a morphologic marker of tumor invasion. The aim of this study was to evaluate the expression of laminin-5 γ2 in OSCC and its association with intensity of tumor budding and density of stromal myofibroblasts. METHODS: Paraffin-embedded archival samples of 57 OSCC patients were evaluated. Immunohistochemistry was employed to detect laminin-5 γ2, alpha smooth muscle actin (marker of stromal myofibroblasts), and multicytokeratin (to identify OSCC cells in tumor budding evaluation). Laminin-5 γ2 expression and its association with intensity of tumor budding and density of stromal myofibroblasts were analyzed. Association among intensity of tumor budding and density of stromal myofibroblasts was also evaluated. RESULTS: Higher laminin-5 γ2 expression was associated with high-intensity tumor budding (P < 0.05) and with higher density of stromal myofibroblasts (P < 0.05). Moreover, high-intensity tumor budding was associated with higher density of stromal myofibroblasts (P < 0.05). CONCLUSIONS: In OSCC, higher laminin-5 γ2 expression is associated with high-intensity tumor budding and with higher density of stromal myofibroblasts, suggesting that this expression is related to the establishment of an invasive phenotype of neoplastic cells and a permissive environment for tumor invasion in this neoplasia.

Dentoskeletal effects of 3 maxillary expanders in patients with clefts: A cone-beam computed tomography study.

INTRODUCTION: The purpose of this study was to evaluate the skeletal and dental changes in the maxillae of patients with clefts treated with 3 expanders: hyrax, fan-type, and inverted mini-hyrax supported on the first premolars. METHODS: Thirty patients with unilateral cleft lip and palate with transverse maxillary deficiency were divided into 3 groups, according to the type of expander that they used. Cone-beam computed tomography images were taken before and 3 months after expansion, and the paired t test was used to evaluate the changes in each group. RESULTS: The subjects in the inverted mini-hyrax group showed significant forward displacement of the maxilla (P <0.05). On the transversal plane, the hyrax group showed greater expansion in the posterior region than in the anterior region (P <0.05). However, the fan-type and the inverted mini-hyrax groups showed significantly greater maxillary expansion anteriorly than posteriorly (P <0.05). There was a greater tendency for buccal inclination of the supporting teeth when the fan-type was used. The cleft and the noncleft sides expanded symmetrically with all appliances, and there was no difference in dental tipping between these sides (P >0.05). CONCLUSIONS: The hyrax expander showed better results for cleft patients requiring anterior and posterior maxillary expansion. The inverted mini-hyrax most effectively restricted posterior expansion, optimizing anterior expansion without causing as much buccal tipping of the supporting teeth as did the fan-type.

Anatomic variations and lesions of the mandibular canal detected by cone beam computed tomography.

PURPOSE: The mandibular canal is a significant anatomical structure in implant dentistry, and cone beam computed tomography (CBCT) is an important diagnostic image modality in this field of dentistry. The aim of this study was to evaluate the frequencies of anatomic variations and lesions affecting the mandibular canal in CBCT images of the mandible produced for dental implant planning. METHODS: This cross-sectional study evaluated a sample of 250 CBCT examinations (500 mandibular canals). The inclusion criterion was CBCT examinations of the mandible requested for dental implant planning. The presence of anatomic variations and lesions affecting the mandibular canal was evaluated in the CBCT examinations. Moreover, the buccolingual position of the mandibular canal was evaluated in the molar region and in the ramus region. The CBCT exams were evaluated by one observer. The data were analyzed using descriptive and analytical statistics. The one-way ANOVA test was employed to compare the age between the anatomic variations. A paired t test was used to compare the buccolingual position between the molar region and the ramus region. Differences were considered significant when p values were lower than 0.05. RESULTS: The anatomic variations detected were large-diameter mandibular incisive canal (51.6 %), ramification (12 %), and accessory mental foramen (3.2 %). No difference was observed in the age of the patients between the anatomic variations (p > 0.05). The identified lesions included hypomineralization of the canal walls (20.8 %), idiopathic osteosclerosis (8.8 %), osteolytic lesions (3.2 %), iatrogenic perforation of the mandibular canal (2.8 %), and fibro-osseous lesions (1.6 %). The distance between the mandibular canal and the vestibular cortical bone was higher in the molar region than in the ramus region (p < 0.05). CONCLUSIONS: Anatomic variations and lesions affecting the mandibular canal were common findings in the CBCT images of the mandible produced for dental implant planning. An awareness of these alterations is important for dentistry because some of them might require treatment, change oral surgery planning and difficult inferior alveolar nerve anesthetic block.

Lymphatic Vascular Density, the Expression of Podoplanin and Tumor Budding in Oral Squamous Cell Carcinoma.

BACKGROUND: Notwithstanding recent advances in oral squamous cell carcinoma (OSCC) management, its mortality rate is still high. It is imperative to investigate new parameters that are complementary to clinical staging for OSCC to provide better prognostic insight. The presence of isolated neoplastic cells or small clusters of up to four cells at the tumor's invasive front, called tumor budding, is a morphological marker of OSCC with prognostic value. Increased lymphatic vascular density (LVD) and a high expression of podoplanin in neoplastic cells have also been associated with worse prognosis in OSCC. To investigate these markers in OSCC, we evaluated differences in LVD and the expression of podoplanin in neoplastic cells between tumors with high-intensity tumor budding versus low-intensity or no tumor budding. In the samples of high-intensity budding, differences in those parameters between the​​ budding area and the area outside the budding were also evaluated. Furthermore, the study assessed differences in LVD and in the expression of podoplanin in neoplastic cells concerning OSCC clinicopathological characteristics. METHODS: To those ends, we subjected 150 samples of OSCC to immunohistochemistry to evaluate the intensity of tumor budding (via multi-cytokeratin immunostaining). Moreover, the 150 samples of OSCC and 15 specimens of normal oral mucosa (used as a control) were employed to assess LVD and the expression of podoplanin (in neoplastic cells of OSCC and in the lining epithelium of normal oral mucosa), both via podoplanin immunostaining. Data were processed into descriptive and analytical statistics. RESULTS: No differences were observed neither in the LVD nor in the expression of podoplanin in neoplastic cells concerning sex, age, tobacco smoking, tumor location and tumor size. The LVD was greater in OSCC and in tumors with high-intensity budding than in normal mucosa but did not differ between normal mucosa and tumors with low-intensity or no tumor budding. The data analyses also revealed that LVD was greater in tumors with high-intensity tumor budding than in tumors with low-intensity or no budding and showed no difference in LVD between the budding area and the area outside the budding. When compared to the lining epithelium of the normal mucosa, the expression of podoplanin was greater in neoplastic cells of OSCC, tumors with high-intensity budding and tumors with low-intensity or no tumor budding. The expression of podoplanin in neoplastic cells was also greater in tumors with high-intensity budding and, within those tumors, greater in the budding area than in the area outside de budding. CONCLUSION: Those findings support the hypothesis that tumor budding is a biological phenomenon associated with the progression and biological behavior of OSCC.

Anatomic variations and lesions of the maxillary sinus detected in cone beam computed tomography for dental implants.

OBJECTIVE: To evaluate the presence of anatomic variations and lesions of the maxillary sinus in cone beam computed tomography (CBCT) of the maxilla required for dental implant planning. MATERIAL AND METHODS: This transversal prevalence study evaluated a sample of 500 consecutive CBCT exams. The inclusion criteria were CBCT exams of the maxilla required for dental implant planning. The CBCT exams were independently evaluated by two oral and maxillofacial radiologists who assessed the presence of anatomic variations and lesions of the maxillary sinus. As most of the CBCT exams did not allow the evaluation of the area close to the maxillary sinus roof, anatomic variations that take place at this site were not assessed. RESULTS: The anatomic variations detected were pneumatization (83.2%), antral septa (44.4%), hypoplasia (4.8%), and exostosis (2.6%). The identified lesions were mucosal thickening (≤3 mm in 54.8% and >3 mm in 62.6%), polypoid lesions (21.4%), discontinuity of the sinus floor (17.4%), air-fluid level (4.4%), bone thickening of the maxillary sinus wall (3.8%), antroliths (3.2%), discontinuity of the sinus lateral wall (2.6%), sinus opacification (1.8%), and foreign body (1.6%). CONCLUSION: Anatomic variations and lesions of the maxillary sinus were common findings in CBCT exams of the maxilla required for dental implant planning. As some of these conditions can modify dental implant planning and must require specialized treatment, its recognition is noteworthy in dental practice, and especially in implantology. The amount and significance of the anatomic variations and lesions detected in this study reinforces the importance of computed tomography in preoperative dental implant planning.

Stromal myofibroblasts in oral leukoplakia and oral squamous cell carcinoma.

OBJECTIVES: Oral leukoplakia (OL) is the main potentially malignant disorder and oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral mucosa. Stromal myofibroblasts play an important role in tumor invasion and metastasis, due to its ability to modify the extracellular matrix. This study aimed to evaluate the presence of stromal myofibroblasts in OL and OSCC. Differences in the presence of myofibroblasts among OL with distinct grades of epithelial dysplasia as well as between histologically high- and low-invasive OSCC were also assessed. STUDY DESIGN: A total of 30 OL and 41 OSCC from archival formalin-fixed, paraffin-embedded specimens were evaluated. 10 samples of normal oral mucosa were used as a control. Myofibroblasts were identified by immunohistochemical detection of alpha smooth muscle actin and its presence was classified as negative, scanty or abundant. Differences in the presence of myofibroblasts among OL with distinct grades of epithelial dysplasia as well as between high- and low-invasive OSCC were analyzed using the Mann-Whitney test. RESULTS: Myofibroblasts were not detected in normal oral mucosa and OL, whatever its histological grade. In OSCC, the presence of stromal myofibroblasts was classified as negative in 11 (26.8%), scanty in 15 (36.6%), and abundant in 15 samples (36.6%). The presence of stromal myofibroblasts was statistically higher in high-invasive OSCC than in low-invasive OSCC (p<0.05). CONCLUSIONS: Stromal myofibroblasts were not detected in OL, indicating that these cells are not important during oral carcinogenesis. Nevertheless, stromal myofibroblasts were heterogeneously detected in OSCC and its presence was higher in tumors with a more diffuse histological pattern of invasion. These findings suggest that myofibroblasts are associated with the creation of a permissive environment for tumor invasion in OSCC.

Endodontic cement penetration after removal of calcium hydroxide dressing using XP-endo finisher.

We aimed to evaluate the penetration of endodontic cement following the removal of calcium hydroxide (Ca(OH)2) dressing using the XP-endo Finisher in association with different irrigating solutions. Sixty premolars were instrumented and applied with a Ca(OH)2 dressing. To remove Ca(OH)2, the teeth were divided into six groups, each with a different volume of sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA), as well as solution stirring time with XP-endo Finisher (0, 30, and 60 sec). Root canals were filled using the lateral condensation technique. Fluorescein dye was added to the cement for microscopic laser scanning analysis. In the generated images, linear measurements were taken in micrometers, and their averages were calculated. To analyze the perimeter penetration ratio of the cement, the total perimeter of the canal and the segment of the total perimeter of the canal where the endodontic cement penetrated into the dentinal tubules were measured in micrometers. We found that using an XP-endo Finisher in irrigation was more effective than using a needle and syringe during the extension and penetration of endodontic cement. Shaking with XP-endo Finisher with 17% EDTA increased the extent and perimeter of the penetration of the endodontic cement into the dentinal tubules. However, using the XP-endo Finisher with EDTA only was more efficient than using the instrument interchangeably in NaOCl and EDTA. Although XP-endo Finisher contributes to the removal of Ca(OH)2, none of the protocols or instruments used removed all Ca(OH)2 from the root system.

Management of orofacial lesions with antimicrobial photodynamic therapy and photobiomodulation protocols in patients with COVID-19: A multicenter case series.

Several oral lesions related to COVID-19 have been described in the scientific literature. The COVID-19 pandemic highlighs importance of supportive protocols, which can reduce the inflammation and aid in tissue repair in severe cases. Photobiomodulation therapy (PBMT) alone or in combination with antimicrobial photodynamic therapy (aPDT) can be used to manage orofacial lesions in confirmed cases of COVID-19. Here, we sought to describe the clinical presentation and specificities of three cases in which aPDT and PBMT were used to manage orofacial lesions in patients with COVID-19. The laser protocols were effective with improvement of the orofacial lesions within a few days.

Push-out bond strength and marginal adaptation of apical plugs with bioactive endodontic cements in simulated immature teeth.

OBJECTIVES: This study evaluates the bond strength and marginal adaptation of mineral trioxide aggregate (MTA) Repair HP and Biodentine used as apical plugs; MTA was used as reference material for comparison. MATERIALS AND METHODS: A total of 30 single-rooted teeth with standardized, artificially created open apices were randomly divided into 3 groups (n = 10 per group), according to the material used to form 6-mm-thick apical plugs: group 1 (MTA Repair HP); group 2 (Biodentine); and group 3 (white MTA). Subsequently, the specimens were transversely sectioned to obtain 2 (cervical and apical) 2.5-mm-thick slices per root. Epoxy resin replicas were observed under a scanning electron microscope to measure the gap size at the material/dentin interface (the largest and smaller gaps were recorded for each replica). The bond strength of the investigated materials to dentin was determined using the push-out test. The variable bond strengths and gap sizes were evaluated independently at the apical and cervical root dentin slices. Data were analyzed using descriptive and analytic statistics. RESULTS: The comparison between the groups regarding the variables' bond strengths and gap sizes showed no statistical difference (p > 0.05) except for a single difference in the smallest gap at the cervical root dentin slice, which was higher in group 3 than in group 1 (p < 0.05). CONCLUSIONS: The bond strength and marginal adaptation to root canal walls of MTA HP and Biodentine cement were comparable to white MTA.

Malignant lesion of clear cells: A diagnostic challenge of an unusual presentation mimicking a benign lesion.

In the oral cavity, a broad spectrum of differential diagnostics includes lesions composed of clear cells. Under this umbrella, Clear Cell Odontogenic Carcinoma (CCOC) and Hyalinizing Clear Cell Carcinoma (HCCC) are rare malignancies that arise from different histological origins. However, the histology is similar; therefore, differentiation of CCOC and HCCC lesions is difficult and, in some cases, impossible to distinguish morphologically and immunohistochemically. Herein, we report an unusual presentation of a well-defined nodular lesion affecting the maxillary gingiva in a 19-year-old female, which presented clinically as a benign or reaction etiology lesion. Microscopic evaluation showed a tumor composed of cell sheets with clear cytoplasm, separated by septa of fibrous tissue and invading the connective tissue. Tumor cells were positive for p63 and AE1/AE3 and negative for PAX8, smooth muscle actin (AML) and estrogen receptor. The diagnosis was carcinoma with a clear cell pattern, and it was not possible to distinguish between HCCC and CCOC. In this study, clinicopathologic, histologic, and immunohistochemistry features of CCOC and HCCC were discussed due to the challenging histological diagnosis. Radical surgical treatment and rehabilitation of the patient through graft and dental implants were performed. The patient is under follow-up with no signs of recurrence.