Symmetrical palatal fibromatosis : an additional case report with immunohistochemical characterization

The term ?symmetrical palatal fibromatosis? was recently suggested to designate bilateral palatal lesions presenting as typically broad, ?mirror? images on the posterior lateral region of the hard palate. We report an additional case of this as-yet poo

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

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

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

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

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

Stafne's bone defect:a systematic review

This systematic review integrated the available data published in the literature on Stafne?s bone defect (SBD), considering the clinical, imaging and histopathological results. An electronic search was undertaken in six databases. Eligibility criteria were: articles in English, Spanish, and Portuguese describing case reports or case series of SBD, reported up to September/2021. Risk of bias was assessed using the Joanna Briggs Institute tool. A total of 98 articles were retrieved, involving 465 individuals with SBD and were included for quantitative analysis. Mean age was 52.78 years (range: 11-89 years), with male predilection (n=374/80.85%). Radiographs were the most frequent imagiological exams (n=298/64.09%), followed by computed tomography (n=98/21.08%). SBD was more prevalent in the posterior mandible (n=361/93.77%) as a hypodense radiolucent lesion (n=250/77.40%). Mean size was 1.58 cm (range: 0.3-.8.0 cm). Two-hundred-and-two lesions (97.37%) were unilocular and 126 (91.97%) were classified as well-defined. Clinical symptoms were reported in 73 cases, while 68 cases (93.15%) were asymptomatic. Only 34 cases (12.32%) were submitted to histopathological examination. Mean follow-up time was 26.42 ±25.39 months. SBD is more frequent in male patients in the fifth and sixth decade of life. Classic SBD is radiographically characterized as a single, unilocular and well-defined lesion in the posterior region of the jaw with a radiolucent/hypodense appearance

Surgical excision of a residual cyst in a patient with previous history of jaw osteonecrosis associated with oral bisphosphonate: A case report

Residual cyst is an inflammatory odontogenic cyst resultant from pulp necrosis, where the tooth has already been removed. Bisphosphonates are drugs used in the prevention and treatment of bone metabolism diseases with intense resorption activity, and they have been associated with osteonecrosis of the jaws, an important side effect. The aim of this study was to report a successful surgical treatment of a residual cyst in a patient who had previously developed jaw osteonecrosis associated with sodium alendronate use. We emphasize here the importance of safe preoperative procedures when approaching these patients.

Acinic cell carcinoma of the oral and maxillofacial region: an international multicenter study

Abstract The aim of this study was to describe the prevalence, clinicopathological, and prognostic features of acinic cell carcinoma (AciCC) of the oral and maxillofacial region. AciCC cases were retrospectively retrieved from 11 pathology centers of three different countries. Medical records were examined to extract demographic, clinical, pathologic, and follow-up information. A total of 75 cases were included. Females (65.33%) with a mean age of 45.51 years were mostly affected. The lesions usually presented as an asymptomatic (64.28%) nodule (95.66%) in the parotid gland (70.68%). The association of two histopathological patterns was the most common finding (48.93%) and the tumors presented mainly conventional histopathological grades (86.11%). Surgical treatment was performed in the majority of the cases (59.19%). Local recurrence was observed in 20% of the informed cases, regional metastasis in 30.43%, and distant metastasis in 12.50%. The statistical analysis showed that the cases with a solid histopathological pattern (p=0.01), high-grade transformation (p=0.008), recurrence (p=0.007), and regional metastasis (p=0.03) were associated with poor survival. In conclusion, high histopathological transformation, presence of nodal metastasis, and recurrence were prognostic factors for AciCC of the oral and maxillofacial region

Macro and microscopic evaluation of lesions induced by oral surgical procedures in rats under therapy with bisphosphonates

A presente pesquisa teve por objetivo comparar a influência dos bisfosfonatos ácido zoledrônico e clodronato no reparo de feridas cirúrgicas induzidas por meio de exodontia e lesão de tecido mole oral. Trinta e quatro ratos (Rattus novergicus, linhagem Wistar) foram distribuídos em três grupos: (1) 12 animais tratados com ácido zoledrônico; (2) 12 animais tratados com clodronato; e (3) 10 animais que receberam solução salina. Decorridos 90 dias do início do tratamento, os animais foram submetidos a exodontias e procedimentos cirúrgicos em tecido mole, ambos na maxila. Aos 180 dias de administração dos fármacos, foi realizada a eutanásia. Após avaliação macroscópica, as maxilas foram processadas, e os cortes histológicos corados por hematoxilina e eosina (H&E), bem como submetidos a processamento imunoistoquímico com os marcadores RANKL, OPG, von Willebrand e caspase-3. Nas lâminas coradas por H&E, foram quantificadas as variáveis osso não-vital, osso vital, infiltrado inflamatório, colônias microbianas, tecido epitelial e tecido conjuntivo, sendo que, no sítio das exodontias, os restos radiculares também foram avaliados. A análise histológica foi realizada por meio do programa Image Pro Plus. Na avaliação macroscópica, no sítio das exodontias o grupo ácido zoledrônico exibiu associação com solução de continuidade da mucosa (qui-quadrado, análise de resíduos ajustados, p<0,001), enquanto na área de lesão de tecido mole, nenhum grupo exibiu essa associação (qui-quadrado, p=0,151). No sítio das exodontias, o grupo ácido zoledrônico exibiu proporção significativamente maior de osso não-vital e colônias microbianas do que os demais grupos. Na lesão de tecido mole, a proporção de osso não-vital e colônias microbianas foi significativamente maior nos grupos ácido zoledrônico e clodronato do que no controle. Não houve diferença significativa das variáveis tecido epitelial, infiltrado inflamatório e resto radicular entre os grupos (Kruskal-Wallis teste de comparações múltiplas, p>0,05). A expressão imunoistoquímica de RANKL, OPG, von Willebrand e caspase-3 também não diferiu significativamente entre os grupos (Kruskal-Wallis, p>0,05). Os resultados permitem concluir que (1) ambos, ácido zoledrônico e clodronato, são capazes de induzir osteonecrose; (2) de acordo com a análise imunoistoquímica, é pouco provável que eventos intrínsecos à mucosa oral sejam os iniciadores da osteonecrose.The aim of this work was to compare clodronate and zoledronic acid effect on the repair of surgical wounds induced by tooth extraction and oral soft tissue lesion. Thirty-four rats (Rattus novergicus, Wistar) were allocated into 3 groups: (1) 12 animals treated with zoledronic acid; (2) 12 animals treated with clodronate; and (3) 10 animals that were given saline solution. Elapsed 90 days from the beginning of the treatment, the animals were subjected to tooth extractions and surgical-induced soft tissue injury in maxillae. At 180 days of drug administration, they were euthanized. After macroscopic evaluation, maxillae were processed and histological cuts were stained with hematoxylin and eosin (H&E). Immunohistochemical expression of RANKL, OPG, von Willebrand and caspase-3 was also evaluated. Non-vital bone, inflammatory infiltrate, microbial colonies, epithelial tissue, connective tissue and vital bone were quantified at the tissue wound sites. At the tooth extraction site, root fragments were also evaluated. The variables were quantified with Image Pro Plus software. Macroscopic analysis at the tooth extraction site showed that zoledronic acid group was associated with loss of mucosal integrity (chi-square, residual adjusted analysis, p<0.001), whereas at the soft tissue wound site, no group showed this association (chi-square, p=0.151). At the tooth extraction site, the zoledronic acid group showed greater proportion of non-vital bone and microbial colonies in comparison with the other groups. At the soft tissue wound site, the proportions of non-vital bone and microbial colonies were greater in the zoledronic acid and clodronate groups than in the control group. There was no significant difference for epithelial tissue, inflammatory infiltrate and root fragments between the groups (Kruskal-Wallis test complemented by its multiple comparisons test, p>0.05). Immunohistochemical expression of RANKL, OPG, von Willebrand and caspase-3 at tooth extraction and soft tissue wound sites did not differ significantly between the three groups analyzed (Kruskal-Wallis test, p>0.05). According to the results, (1) both bisphosphonates zoledronic acid and clodronate are capable of inducing osteonecrosis; (2) the immunohistochemical analysis suggests that the involvement of soft tissues as the initiator of osteonecrosis development is less probable than has been pointed out