A retrospective analysis of oral and maxillofacial pathology in a pediatric population from Rio de Janeiro?Brazil over a 75-year period

The aim of this study was to analyze the distribution of oral and maxillofacial lesions affecting children and adolescents patients from a single oral pathology laboratory from Rio de Janeiro, Brazil. Oral and maxillofacial lesions biopsied in patients younger than 19-years were retrieved from the oral pathology files of the Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro over a 75-year period (1942-2017). The clinical data and the diagnoses of each case were included in a Microsoft Excel® database, being classified into 13 categories according to the etiology. A descriptive analysis of the variables age, gender and final diagnosis was made. From 19.095 lesions diagnosed in this period, 2408 (12.61%) were from patients aged 0 to19 years, with a higher incidence in females in the second decade. Salivary gland pathology was the most common group of lesions (24.30%), followed by reactive lesions (16.82%) and odontogenic cysts (14.66%). Mucocele was the most common lesion (21.72%), followed by dentigerous cyst (6.48%) and fibrous hyperplasia (6.44%). Malignant lesions were observed in 1.12% of all cases with Burkitt lymphoma as the most frequent. Our results were similar to previous studies and knowledge of these data may contribute to the understanding of oral lesions that most commonly affects children

Extraskeletal myxoid chondrosarcoma of the masticator space in a pediatric patient

Extraskeletal myxoid chondrosarcoma (EMC) is a malignant soft-tissue neoplasm rarely described in the head and neck region of children and adolescents. We describe a case of EMC affecting the masticator space and a literature review. A 13-year-old boy who presented a large painless, diffuse mass causing progressive midfacial asymmetry of 6 months duration. Histopathological evaluation revealed a multinodular lesion, containing scattered round vacuolated tumor cells dispersed in an abundant myxoid stroma, separated by fibrous septae. Immunohistochemical analysis revealed positivity for vimentin, neuron-specific enolase, and chromogranin. The Ki-67 labelling index was 42%. The patient was treated surgically with tumor resection followed by adjuvant local radiotherapy. The patient died 1 year after initial diagnosis due to locoregional tumor dissemination. EMC should be considered in the differential diagnosis of myxoid neoplasms in the head and neck region

Synchronous metastatic cutaneous squamous cell carcinoma and chronic lymphocytic leukaemia/small lymphocytic lymphoma in a cervical lymph node: case report of an unusual event

The synchronous occurrence of two different neoplasias is an uncommon event, which may arise between tumors originating in the same organ or in cancer-to-cancer metastasis. We report a rare case of chronic lymphocytic leukaemia / small lymphocytic lymphoma associated with a cutaneous metastatic squamous cell carcinoma in a cervical lymph node. In the affected lymph node, it was observed an effacement of the normal architecture by neoplastic lymphocytes and it was noted the presence of neoplastic invasive epithelial islands. Immunohistochemical analysis demonstrated that lymphocytic proliferation was positive for CD20, CD5, CD23 and Kappa, and negative for CD3, CD10, Cyclin D1 and Lambda. The morphological and immunohistochemical profile lead to a phenotype of B-cell chronic lymphocytic leukaemia / small lymphocytic lymphoma. The epithelial cells were positive for CK5, thus rendering the diagnosis of synchronous metastatic cutaneous squamous cell carcinoma and chronic lymphocytic leukaemia/small lymphocytic lymphoma. Literature supports the poor prognosis in cases that present coexistence of squamous cell carcinoma and chronic lymphocytic leukaemia / small lymphocytic lymphoma. Thus, it is necessary to be aware about this unusual finding in order to provide specific treatment

Clear cell variant of calcifying epithelial odontogenic tumor: case report with immunohistochemical findings

Calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm, locally aggressive, characterized by sheets and nests of polyhedral epithelial cells exhibiting eosinophilic cytoplasm or less often clear cytoplasm. Additional features include nuclear pleomorphism without mitotic activity, concentric calcifications, and deposits of amyloid. Herein, we present an additional example of clear cell variant of CEOT occurring in a 25-year-old female. Microscopically, the tumor consisted on proliferation of epithelial cells with eosinophilic, clear vacuolated cytoplasm interspersed with focal areas of amyloid deposition. Tumor cells were immunopositive for AE1/AE3, CK14, CK19, ß-catenin, CD138, and p63

Immunohistochemical expression of Skp2 protein in oral nevi and melanoma

Objective: The aim of this study was to analyze the immunohistochemical expression of Skp2 protein in 38 oral nevi and 11 primary oral melanomas. Study Design: Expression of this ubiquitin protein was evaluated by immunohistochemistry in 49 oral melano - cytic lesions, including 38 intramucosal nevi and 11 primary oral melanomas. The labeling index (LI) was as - sessed considering the percentage of cells expressing nuclear positivity out of the total number of cells, counting 1000 cells per slide. Results: Skp2 protein was rarely expressed in intramucosal nevi, in contrast to oral melanomas, which showed high levels of this protein. Conclusion: These results indicate that Skp2 protein may play a role in the development and progression of oral melanomas, and it also could be useful as an immunohistochemical marker for differential diagnosis of oral be - nign and malignant melanocytic lesions

Psammomatoid juvenile ossifying fibroma of frontal sinus – surgical and reconstructive approach

Psammomatoid juvenile ossifying fibroma (PJOF) is a benign fibro-osseous lesion that mainly affects the paranasal sinuses and periorbital bones. It may cause significant esthetic and functional impairment. Herein, we describe the diagnosis and surgical approach of an extensive PJOF arising in the frontal sinus of a young male. After complete lesion removal and histopathological confirmation, the bone defect was repaired with a customized polymethylmethacrylate implant. PJOF may present aggressive clinical behavior. The excision of extensive PJOF in the orbitofrontal area can result in significant esthetic defects. Polymethacrylate implants restore functionally and esthetically the involved area

Hyperpigmentation of hard palate induced by chloroquine therapy

Abstract The antimalarials are one of the most commonly prescribed drugs for conditions such as lupus erythematosus and rheumatoid arthritis, and the side effects, though infrequent, are well known. The antimalarial agent chloroquine diphosphate usually causes pigmentary changes in the oral mucosa characterized by a bluish-grey to black discolorations mainly in the hard palate. Considering only the hard palate hyperpigmentation caused by chloroquine, to the best of our knowledge, only 13 cases have been reported in the English language literature. We described an additional case of palate hyperpigmentation related to the chronic use of chloroquine diphosphate in a 60-year-old Mexican woman. Although the diagnosis is usually made based on medication history and clinical presentation, a biopsy specimen may be helpful to confirm the diagnosis. Clinicians must be aware of these drugs and their adverse effects in order to make the correct diagnosis and decide on the optimal treatment for the condition. Key words: Oral cavity, hard palate, hyperpigmentation, chloroquine, antimalarial

Paracoccidioidomycosis in a 64-year-old man: a case report

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by the thermo-dependent dimorphic fungus Paracoccidioides spp, limited to the American continent, but with a high incidence in Brazil, mainly in the Midwest, South and Southeast regions. This is a case report of a 64-year-old male patient that was referredat a hospital, complaining of pain in the mouth and dysphagia. The patient presented multiple and finely granular hemorrhagic pinpoint erosions with a mulberry-like appearance in oral mucosa. The patient underwent an incisional biopsy, and the histopathological analyses confirmed the presence of the fungus and the diagnosis of PCM. Lesions in oral mucosa may be the first visible clinical manifestation of PCM; so, a meticulous evaluation of oral cavity and well-conducted diagnostic techniques are indispensable for a correct diagnosis and an appropriate therapy of PCM

Myeloid sarcoma of the oral cavity : a case report and review of 89 cases from the literature

Myeloid sarcoma is a tumor mass of immature myeloid or granulocytic cells that affects extramedullary anatomic sites, including uncommonly the oral cavity. A 24-year-old female was referred for evaluation of a fast growing painful gingival swelling lasting 2 weeks, associated with fever, fatigue, and cervical lymphadenopathy. Intraoral examination showed a bluish swelling on the right posterior lower gingiva exhibiting necrotic surface. Incisional biopsy of the gingival lesion displayed diffuse infiltration of undifferentiated tumor cells with granulocytic appearance, strongly immunopositive for CD99, myeloperoxidase and Ki-67 (60%), and negative for CD20, CD3, CD34 and TdT. Blood tests presented a severe pancytopenia, and genetic analysis confirmed the diagnosis of acute promyelocytic leukemia. The final diagnosis was of oral myeloid sarcoma associated with acute promyelocytic leukemia with t(15;17). The patient was submitted to chemotherapy but died of the disease one month later. The clinicopathologic and immunohistochemical features of the present case are compared with the 89 cases of oral myeloid sarcoma previously reported in the English-language literature

Primary oral melanoma : a histopathological and immunohistochemical study of 22 cases of Latin America

Objective: The aim of this study was to analyze the histopathological and immunohistochemical characteristics of 22 cases of primary oral melanomas (OM). Study Design: Twenty two cases of primary oral melanoma were analyzed by description of their histopathological features and immunohistochemical study using the antibodies S-100, HMB-45, Melan-A and Ki-67. Results: The mean age was 58 years and 14 cases were female. The main affected sites were the hard palate, followed by the upper gingiva. Microscopically, 15 cases presented level III of invasion, 2 cases were amelanotic and 13 showed a mixed epithelioid and plasmacytoid or spindle cells composition. Some cases showed necrosis, perivascular and perineural invasion. S-100 and HMB-45 were positive in all cases, but 3 cases were negative for Melan-A. The proliferative index with Ki-67 was high, with labeling index ranging from 15.51% to 63% of positive cells. Conclusion: S-100 and HMB-45 are more frequently expressed than Melan-A in primary oral melanomas and these markers are helpful to confirm the diagnosis