Simple and aneurysmal bone cyst : aspects of jaw pseudocysts based on an experience of Brazilian pathology service during 53 years

Jaw pseudocysts are benign osseous lesions of unclear etiology. Among these, the simple bone cyst (SBC) and aneurysmal bone cyst (ABC) are intriguing bone pathologies still rarely studied together. This retrospective study aimed to present the long-term case series of patients with jaw pseudocysts focusing on the clinical, radiographic, and transoperative aspects. A retrospective case series of patients with SBC and ABC was performed. Clinical, radiographic, and transoperative aspects of both pseudocysts were reviewed from the histopathological archives of 20,469 cases between 1959-2012. All descriptive data were summarized. Of 354 (15.25%) bone pathologies, 54 cases of jaw pseudocysts were found, with 42 (11.86%) SBC and 12 (3.39%) ABC cases. For both lesions, most of the sample were young Caucasian women with an asymptomatic posterior mandible lesion with undetermined time of evolution and none trauma history. A unique radiolucent scalloped lesion presenting an empty cavity were also observed for both conditions. However, some atypical findings were found for SBC including: the expansion of bone cortical, tooth resorption, displacement of the mandibular canal, and recurrence. The absence of painful symptoms and the lack of classical blood-filled cavity were observed in some cases of ABC. The SBC and ABC are bone pathologies with few retrospective studies, no previous studies on the two conditions, varied nomenclature, and atypical aspects in some cases. Therefore, the knowledge of clinical, imaging, and transoperative features of such pseudocysts are clinically valuable as diagnosis hypothesis of radiolucent lesions of the jaws

Demographic profile of oral nonodontogenic cysts in a Brazilian population

Objectives: The purpose of this study was to determine the clinical and demographic characteristics of oral non- odontogenic cysts (ONOC) in a Brazilian population over a 53-year period and to compare this data with the literature. Study D esign: A total of 20.391 biopsies records were evaluated, from April/1959 to August/2012. Cases of oral developmental cysts were selected. Data regarding age, gender, time of evolution, and anatomic site of all cases were collected. The data were analyzed by descriptive statistics. Results: Among 20.391 oral biopsies, 71 (0.35%) met the criteria of ONOC. Females accounted for 50.70% of all cases. The mean age observed was 38.14 years (range: 5-88 years). Nasopalatine duct cysts, oral lymphoepithelial cysts and epidermoid cysts were the most common ONOC, accounting for 63 cases (88.73%). Nasopalatine duct cysts occurred in 31 cases (43.66%), followed by 22 patients with oral lymphoepithelial cysts (30.99%) and 10 cases of epidermoid cysts (14.08%). Nasopalatine duct cysts revealed predominance among males (58.06). Oral lymphoepithelial cysts were more commonly observed in tongue (50%). Epidermoid cysts were most frequently found in the buccal mucosa (40.00%). Conclusions: The differential diagnosis of ONOC is based on the clinical, radiological, and histological findings. It is difficult to establish an epidemiological profile of ONOCs, considering the low frequency of these lesions and the divergences in the demographic and clinical presentation data among different populations

Angina bullosa hemorrhagica: a rare condition?

Angina bullosa hemorrhagica is characterized by oral mucosal blood-filled vesicles or blisters. These lesions, however, are frequently asymptomatic and they are only observed when their content is spilled over the oral cavity. Objective: The aim of this study was to perform a retrospective evaluation of Angina Bullosa Hemorrhagica (ABH) cases diagnosed in patients referred to the Diagnosis Center of Oral Diseases of the Dentistry School of Federal University of Pelotas, over a 4-years period. Material and methods: All the clinical records from this period were reviewed and Angina Bullosa Hemorrhagica could be diagnosed in 47 patients. The following information pertaining to the patient and the lesion were collected from the dental record: gender, age, ABH site, size of the lesion, presence of symptoms, bleeding, likely predisposing factors, treatment and recurrence of the lesion. Results: The results revealed 47 patients with clinical features of ABH, 26 were female and 21 were male, with ages between 42 to 87 years. Thirty-six patients (76.6%) developed the lesion in the palate. Pain was reported by 17 patients (36.2%) and bleeding by 19 patients (40.4%). Seventeen patients (36.2%) reported the occurrence of the lesion following trauma. Conclusion: It is possible to conclude that although ABH has been traditionally described as a rare condition, the data obtained in this study suggest a fairly high occurrence of the disease

Clinicopathologic and immunohistochemical characterization of 14 cases of angioleiomyomas in oral cavity

Angioleiomyoma (ALM) is a benign neoplasm that originates from vascular smooth muscle. It is extremely rare in oral cavity. The objective of this study was to evaluate the clinicopathological and immunohistochemical characteristics of all oral angioleiomyomas registered in a Center of Diagnosis of Oral Diseases from 1959 to 2017. Slides from 14 cases of ALM stained with hematoxylin and eosin (H&E) were analyzed to confirm the diagnosis. Moreover, an immunohistochemical panel with alpha-smooth muscle actin (alpha-SMA), desmin, AE1/AE3, CD68, S-100, and CD34 antibodies was performed to evaluate semi-quantitatively the positive cells. ALM correspond to 0.08% of all benign oral tumors analyzed during the 57-year period. The mean age of the patients was 45 years with a predilection to males (58%). The most frequently reported site was lips (50%). Microscopic analysis on H&E sections revealed similar pattern in all cases, showing well-circumscribed and encapsulated tumors, characterized by a proliferation of smooth muscle cells and wide vascular spaces of varying sizes. The predominant immuno profiles were: alpha-smooth muscle actin (alpha-SMA) positive (strong immunoreactivity); positive variable pattern for desmin, negative immunoprofile for AE1/AE3, CD68, and S-100. The endothelial cells of vascular spaces were CD34+. Based on the results, the alpha-SM actin can be elected as a good marker for angioleiomyomas and can help the confirmation of the morphologic diagnosis of this lesion

Oral bilateral collagenous fibroma : a previously unreported case and literature review

Collagenous fibroma, also known as desmoplastic fibroblastoma, is a rare benign slow growing tumor particularly uncommon in the oral cavity. The aim of this study was to analyze the clinical and histopathological features of an oral collagenous fibroma as well as to compare this data with those reported in an English-literature review. The thirteenth case of collagenous fibroma in the oral cavity and the first to present clinically as a bilateral mass was described. A 48-years-old female patient was referred to a School of Dentistry, complaining about an asymptomatic swelling on the hard palate, lasting around ten years. The intraoral examination revealed two well-defined mass, bilaterally in the hard palate. An excisional biopsy was performed. Microscopically, the connective tissue consisted of dense collagen bundles in which were seen scarcely distributed spindle-shaped to stellate fibroblastic cells. Blood vessels were few, as well as inflammatory cells. Immunohistochemical staining was positive for vimentin, ?-smooth muscle actin and factor XIIIa and negative for S-100, CD68, CD34, HHF35, desmin and AE1/AE3. The patient remains disease-free 24 months after excision. In conclusion, oral collagenous fibroma should be included in the differential diagnosis of bilateral sessile nodules in the oral cavity

Retrospective analysis of jaw biopsies in young adults. A study of 1599 cases in Southern Brazil

To evaluate the prevalence and the characteristics of jaw lesions diagnosed in young adults aged 20 to 30 years in a southern Brazil reference center, over a period of 25 years. And to analyze the concordance between clinical and histological diagnosis. In this cross-sectional retrospective study, the biopsies files from this center were retrieved and data regarding sex, age, bone localization, clinical and histological diagnosis were collected. The histological diagnosis were grouped into the categories Cystic lesions of odontogenic origin, Periapical inflammation, Odontogenic tumors, Bone diseases, Health tissue and Nonspecific diagnostic. Absolute and relative frequencies were estimated with descriptive analysis. The agreement between clinical and histological diagnosis was measured through Kappa statistic. A total of 18,181 histopathological analysis were performed during the period of the study, registering 1,599 jaw lesions in young adults. The average age of individuals was 24,59 years (SD 3,1). Nine hundred ninety-one (62%) lesions were found in females and 608 (38%) in males. More than half of pathologies were cystic lesions of odontogenic origin (822/51.4%), followed by periapical inflammation (282/17.6%). Regarding the site of lesions, more than half occurred in posterior mandible (877/54.8%), followed by posterior maxilla (339/21.2%). The most frequent entities were periapical cyst, chronic periapical granuloma, dental follicle and paradental cyst, corresponding to a total of 1,202 (75.2%) evaluated cases. In relation to the analysis of concordance between clinical and histological diagnosis the general Kappa index was 0.5, which is considered moderate. Finally, the findings confirm data from literature about the most frequent jaw pathologies in young adults and serve as aid for preventive measures of some entities. Additionally, they can improve the formulation of differential diagnosis and the patient management

Leucoplasia e eritroplasia intraoral em adultos jovens

O presente estudo tem como objetivo avaliar a frequência, as características clínicas, demográficas e histopatológicas da LO e EO em adultos jovens, com base em um estudo retrospectivo de três Centros brasileiros de referência em Patologia Oral

Diclofenac in hyaluronic acid gel: an alternative treatment for actinic cheilitis

OBJECTIVE: Actinic cheilitis (AC) is a precancerous lesion of the lip vermillion caused by prolonged exposure to ultraviolet light. The aim of this study was to evaluate the effect of 3% diclofenac in 2.5% hyaluronic acid gel in the treatment of AC. METHODS: Thirty-four patients with chronic AC were treated twice a day with topical diclofenac during a period of 30 to 180 days. The individuals were followed up every 15 days by means of clinical examination and digital photographic documentation. RESULTS: Of the 27 patients that completed the study, 12 (44%) showed complete remission of the whitish plaques and exfoliative areas, and 15 (56%) had partial remission of the clinical picture of cheilitis. The latter group was submitted to excision of the leukoplakic areas which diagnosis varied from mild to moderate epithelial dysplasia. CONCLUSIONS: The results suggest a promising role for diclofenac in hyaluronic acid gel in the treatment of AC. This treatment has the advantages of not being invasive and showing few side effects

Hiperplasia endotelial papilar intravascular

El presente estudio tuvo como objetivo contribuir a la literatura con un caso desafiante de una lesión asintomática que muestra un aspecto radiolúcido en la mandíbula, simulando un quiste residual. Una mujer de 60 años presentó una lesión en la mandíbula, detectada durante los exámenes de imagen. La Tomografía Computarizada reveló una lesión hipodensa con margen esclerótico de aproximadamente 0,8 x 0,8 x 0,7 cm en la región posterior derecha de la mandíbula. El principal diagnóstico diferencial fue un quiste residual y se realizó una biopsia excisional. El análisis microscópico reveló proyecciones papilares y trombos en el lumen del vaso revestido de endotelio. El análisis inmunohistoquímico fue positivo para CD34 y actina de músculo liso. Con base en estos hallazgos, la lesión fue identificada como hiperplasia endotelial papilar intravascular intraósea. Este informe de caso proporciona información sobre esta hipótesis potencial de radiolucencia unilocular ubicada en los huesos de la mandíbula

Perfil Imunohistoquímico de Ki-67, 8-Ohdg, Bax E Bcl-2 em Leucoplasia Oral e Carcinoma Espinocelular em pacientes com até 40 anos: dados preliminares de uma análise comparativa

As desordens orais potencialmente malignas (DOPMs) são definidas como alterações na mucosa oral associadas com aumento de risco de desenvolvimento de câncer (WARNAKULASURIYA, 2021). A leucoplasia oral (LO), a mais comum entre as DOPMs, tem prevalência estimada entre 2,60% e 4,11% (MELLO, 2018), com o tabaco e o consumo excessivo de álcool constituindo seus principais fatores de risco. Estima-se que a taxa global de transformação maligna da LO varie entre 1,1% e 40,8%, - o que pode ser atribuído à diversidade de patologias sob esse diagnóstico clínico (AGUIRRE-URIZAR, 2021). A graduação histopatológica da displasia epitelial oral (DEO) representa o principal método para avaliar o risco de transformação maligna em DOPMs. No entanto, a falta de consenso entre os patologistas sobre a avaliação histológica da presença e do grau de displasia é evidente. (ODELL, 2021)