Challenging of treating patients with exfolliative cheilittis: Report of two cases

Cheilitis is a term given to the inflammation that occurs in the vermillion of the lips. The exfoliative type is an uncommon form of cheilitis, which is characterized by inflammation and desquamation of the lip. It can cause aesthetic problems and compromise daily eating and phonation. The aim of this paper is to describe two cases of exfoliative cheilitis in young persons under periods of emotional stress and parafunctional habits. A 22-year-old white male and an 18-year-old black female presenting edema, intense dryness, and slight desquamation on the vermilion of the lips. In the second case, fissures with bleeding were also observed. Oral lesions were associated with intense emotional stress. The diagnosis of both was made based on the clinical presentation and the exclusion of other conditions. Although the patients have presented a significant improvement after the corticosteroid treatment, they still have a recurrence in stressful episodes. Detailed clinical examination and complementary exams are fundamental for determining associated factors and correctly diagnosing exfoliative cheilitis. Treatment can be challenging, especially in the face of relapses. Key words:Cheilitis, exfoliative cheilitis, oral lesions, stress psychological

Carcinoma adenóide cístico: revisão da literatura e relato de caso clínico

O carcinoma adenóide cístico (CAC) é neoplasia maligna de glândula salivar que acomete principalmente as glândulas parótidas, as submandibulares e as salivares acessórias, sendo raro nas glândulas sublinguais. Com crescimento lento e natureza infiltrativa, clinicamente apresenta-se como nódulo de consistência endurecida. O presente trabalho teve como objetivo revisar a literatura atual sobre o tema em relação aos aspectos clínicos e histopatológicos, bem como relatar um caso de CAC na região submandibular

Coexistência de pênfigo vulgar e infecção pelo vírus herpes simples na mucosa oral Coexistence of pemphigus vulgaris and herpes simplex virus infection in oral mucosa

O pênfigo vulgar é uma doença mucocutânea, imunomediada, caracterizada por lesões vesiculobolhosas, enquanto a infecção pelo vírus herpes simples (HSV) é comum na cavidade oral. A coexistência das duas doenças tem sido relatada por alguns autores. Este artigo relata o caso de um paciente com múltiplas lesões em várias áreas da mucosa oral, cujo procedimento foi raspagem e biópsia incisional, que resultou no diagnóstico de pênfigo vulgar associado à infecção pelo HSV. Destaca-se a inusitada associação das doenças e a identificação citopatológica de duas populações celulares com aspectos morfológicos distintos e característicos, capazes de determinar o correto diagnóstico, sendo fundamental para a conduta e terapêutica adequada.<br>Pemphigus vulgaris is an autoimmune mucocutaneous disease, characterized by vesiculobullous lesions. Herpes simplex virus (HSV) infection is common in the oral cavity and the coexistence of pemphigus vulgaris and HSV infection has been reported by some authors. In this work, we report a case of a patient with multiple lesions involving several areas of the oral mucous membrane. Based on scraping cytology and incisional biopsy findings, the diagnosis was pemphigus vulgaris associated with HSV infection. We call attention to the uncommon association of both diseases and the cytological identification of two cell populations with different and characteristic morphological aspects, able enough to establish the correct diagnosis and define an appropriate therapeutic approach

Estudo comparativo de raspados orais submetidos à técnica de citologia em meio líquido e citopatologia convencional Comparative study of oral smears applying liquid-based cytology and conventional cytopathology

INTRODUÇÃO: Quando comparada à técnica da citopatologia convencional (CC), a citologia em meio líquido (LBC) tem sido referida como método de desempenho superior em esfregaços cervicouterinos. OBJETIVO: Comparar (quantitativa e qualitativamente) esfregaços orais preparados por meio da citopatologia convencional e da LBC. Material e métodos: Foram realizados raspados em borda lateral da língua de seis indivíduos com mucosa oral de aspecto clínico normal, e testados três instrumentos de coleta: escova endocervical (cytobrush), espátula plástica e escova contida no kit da citologia em meio líquido utilizado no estudo, sendo os esfregaços submetidos à citopatologia convencional e à LBC. RESULTADOS: A escova endocervical mostrou-se mais adequada para coleta e quanto ao método, a LBC forneceu lâminas com distribuição celular mais regular e homogênea do que a citopatologia convencional. Notou-se ainda redução da quantidade de células inflamatórias e de colônias de bactérias. DISCUSSÃO: Mesmo em menor quantidade, a sobreposição celular não foi totalmente eliminada na LBC como a literatura relata, pois estava presente em algumas lâminas. Embora em amostras cervicouterinas a redução de células inflamatórias, de hemácias e de muco seja considerada uma vantagem da LBC, nos raspados orais muitas vezes esses elementos compõem aspectos significativos de determinada doença. CONCLUSÕES: A citologia em meio líquido pode ser uma nova técnica a ser somada aos exames auxiliares de diagnóstico oral, mas, apesar de apresentar alguns resultados favoráveis, ainda são necessárias adaptações ao utilizá-la no diagnóstico oral.INTRODUCTION: When compared to conventional cytopathology (CC), liquid-based cytology (LBC) has been referred to as a method of superior performance in cervical smears. OBJECTIVE: To quantitatively and qualitatively compare oral smears obtained through conventional cytopathology and liquid medium cytology. MATERIAL AND METHODS: Six individuals with normal oral mucosa had the lateral border of their tongues scraped. Three collecting instruments were tested in this process: endocervical brush (cytobrush), a plastic spatula, and the LBC kit brush. Both methods, CC and LBC, were applied. Results: The endocervical brush was the most appropriate collecting instrument; as far as method is concerned, liquid medium cytology provided slides with more regular and homogeneous cellular distribution in comparison to conventional cytopathology. There was also a reduction in the number of inflammatory cells and bacteria colonies. DISCUSSION: Cellular overlapping was not totally eliminated in the liquid medium cytology as reported in medical literature, inasmuch as it was present in some slides, though in a smaller amount. Although in cervical samples the reduction of inflammatory cells, erythrocytes and mucus is considered an advantage of LBC, in oral smears these elements may represent significant aspects of some oral diseases. CONCLUSIONS: Liquid-based cytology may be an additional technique to be used with complementary exams in oral diagnosis, but despite the fact it presents some favorable results some adaptations are still necessary for its use in oral diagnosis

Prevalence of oral hairy leukoplakia and epithelial infection by Epstein-Barr virus in pregnant women and diabetes mellitus patients cytopathologic and molecular study

Oral hairy leukoplakia (OHL) is generally reported in patients with severe immunosuppression, except for a few cases in individuals with moderate degree of immunodeficiency. It is a white lesion that appears mainly in the lateral border of the tongue, caused by Epstein-Barr virus (EBV). The nuclear changes caused by EBV (Cowdry A inclusion, ground glass and nuclear beading), observed in cytopathology, are specific and enough for the definitive diagnosis of OHL, independent of the identification of the virus. Here we investigated the prevalence of OHL and the presence of EBV-DNA in the lateral borders of the tongue from 90 pregnant women, 90 diabetes mellitus (DM) patients, 30 healthy individuals (negative group) and 30 HIV+ with OHL (positive group). Smears were analyzed by cytopathology and polymerase chain reaction (PCR). A case of subclinical OHL and candidiasis was identificated in a DM patient by cytopathologic analysis. PCR results demonstrated EBV-DNA in 65% of the pregnant women, in 35% of DM patients, and in 20% of the healthy individuals. We concluded that DM patients can develop OHL with a low prevalence. Furthermore, the prevalence of the EBV in lateral border of the tongue is larger in pregnant women than in healthy individuals

Língua geográfica e atopia: existe associação?

Objective: this systematic literature review aimed to find data to clarify a controversy about the association between geographic tongue and atopic diseases/atopy. With emphasis on the relationship between these conditions. Material and Methods: data extracted include information on age and sex, family and personal history of atopy, geographic tongue prevalence, immunoglobulin E (IgE) serum levels, and skin tests. Results: 08 articles were selected and read in full text and information in articles used in this study. During a review, there was difficulty in standardizing the findings due to lack of details in the diagnosis of atopy and geographic tongue; and the lack of separate analysis of the conditions of asthma, rhinitis or atopic dermatitis. Limitation: low number of publications on the subject. Conclusion: based on the literature, more data are available to confirm the relationship between geographic tongue, atopic diseases / atopy, new ones with larger sample sizes, adequate diagnosis of atopy / atopic diseases and geographic tongue, IgE serum levels determined simultaneously oral examination and skin tests.Resumo: Objetivo: esta revisão sistemática da literatura teve como objetivo encontrar dados que esclarecessem a controvérsia sobre associação entre língua geográfica e doenças atópicas/atopia, enfatizando a correlação entre estas condições. Material e Métodos: os dados avaliados incluíram idade, sexo, história familiar e pessoal de atopia, prevalência de língua geográfica, níveis séricos de imunoglobulina E (IgE) e testes cutâneos. Resultados: 08 artigos foram selecionados e lidos na íntrega e as informações encontradas utilizadas neste estudo. Durante a revisão, houve dificuldade na padronização dos achados devido à falta de detalhes no diagnóstico de atopia e língua geográfica; e falta de análise individualizada das condições atópicas: asma, rinite ou dermatite atópica. Limitação: baixo número de publicações sobre o tema. Conclusão: com base na literatura, um número maior de dados são necessários para confirmação da relação entre língua geográfica, doenças atópicas/atopia, além de outros estudos com tamanho amostral maior, diagnóstico detalhado de atopia/ doenças atópicas e língua geográfica e dosagem sérica IgE determinada simultaneamente ao exame bucal e testes cutâneos