RESUMO
O fibroma ossificante juvenil trabecular (FOJTr) é uma lesão fibro-óssea benigna rara de comportamento agressivo, alto potencial de recorrência, e acometimento no esqueleto craniofacial de crianças e adolescentes. Uma paciente do gênero feminino, 8 anos de idade, compareceu ao ambulatório de Patologia Oral e Maxilofacial da Universidade de Gurupi UNIRG para avaliação clínica de um aumento de volume na região de corpo da mandíbula do lado esquerdo. Não havia sintomatologia dolorosa e sequer desconforto. Nos exames de imagem (radiografia panorâmica e tomografia computadorizada) foram observados uma extensa área radiolúcida que se estendia desde o primeiro molar permanente com rizogênese incompleta até o incisivo central do lado oposto. Após a realização da biópsia incisional e laudos histopatológicos realizou-se a remoção completa da lesão incluindo os remanescentes decíduos sobrejacentes ao fibroma. Nas imagens de controle pós-operatório aos 90 dias (radiografia panorâmica e tomografia computadorizada), notou-se sinais de neoformação óssea com espessamento basilar e os germes dos dentes permanentes em franco desenvolvimento. Diante disso, ressalta-se a importância do conhecimento dos aspectos clínicos, radiográficos e histopatológicos para a realização de um correto diagnóstico e tratamento adequado afim de reduzir as altas taxas de recidivas... (AU)
Trabecular juvenile ossifying fibroma (TrJOF) is a rare benign fibro-osseous lesion, with aggressive behavior, high recurrence potential, which affects the craniofacial skeleton of children and adolescents. This paper aims to describe a clinical case in a female patient, 8 years old, who attended the Oral and Maxillofacial Pathology outpatient clinic Faculty of Dentistry University of Gurupi - UNIRG, city of Gurupi - TOCANTINS - BRAZIL for clinical evaluation of an increased in volume in the region of the mandible body, on the left side. There was no painful symptomatology or even discomfort. Imaging examinations (panoramic radiography and computed tomography (CT) showed an extensive radiolucent area that extended from the first permanent molar with incomplete root formation to the central incisor on the opposite side. After performing an incisional biopsy and histopathological examination, the lesion was completely removed included the remainder deciduous teeth overlying the tumor. In the postoperative control images at 90 days (panoramic radiography and CT), signs of bone neoformation with basilar thickening and the germs of the permanent teeth in full development were noted. In view, this importance of knowledge of clinical, radiographic and histopathological aspects is emphasized for the realization of a correct diagnosis and adequate treatment in order to reduce the high rates of relapses... (AU)
El fibroma osificante trabecular juvenil (TRFOJ) es una lesión fibroósea benigna rara con comportamiento agresivo, alto potencial de recurrencia y afectación del esqueleto craneofacial de niños y adolescentes. Paciente femenina de 8 años de edad que acude al ambulatorio de Patología Oral y Maxilofacial de la Universidad de Gurupi - UNIRG para evaluación clínica de aumento de volumen en la región del cuerpo mandibular del lado izquierdo. No presentaba sintomatología dolorosa ni molestias. Los exámenes de imagen (radiografía panorámica y tomografía computarizada) mostraron una extensa área radiolúcida que se extendía desde el primer molar permanente con formación radicular incompleta hasta el incisivo central del lado opuesto. Tras realizar la biopsia incisional y los informes histopatológicos, se procedió a la extirpación total de la lesión, incluidos los remanentes caducos que recubrían el fibroma. En las imágenes de control postoperatorio a los 90 días (radiografía panorámica y tomografía computarizada), se observaron signos de neoformación ósea con engrosamiento basilar y los gérmenes de los dientes permanentes en pleno desarrollo. Por tanto, es importante conocer los aspectos clínicos, radiográficos e histopatológicos para la realización de un diagnóstico correcto y un tratamiento adecuado con el fin de reducir las altas tasas de recaídas... (AU)
Assuntos
Humanos , Feminino , Criança , Neoplasias Ósseas/diagnóstico , Fibroma Ossificante/diagnóstico , Osso Esponjoso/patologia , Biópsia , Radiografia Panorâmica , Neoplasias Mandibulares/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Clear cell odontogenic carcinoma (CCOC) is a rare malignant odontogenic tumor. It is characterized by showing, on histopathological examination, clusters of vacuolated and clear tumor cells with epithelial differentiation surrounded by fibrocollagenous stroma and fibroblasts. The present study presents a rare clinical case of mandibular CCOC associated with an impacted tooth in a 26-year-old woman surgically treated with mandibulectomy and reconstruction with iliac crest bone graft. The patient has been followed up for 22 months without signs of recurrence. A search for case report/case series was carried out in the PUBMED database, as well as in the references of relevant previously published literature reviews. Ninety-six publications were identified, totaling 136 distinct cases reported. Female sex was the most affected (63.1%) with 63.3% of cases occurring in patients in the fifth, sixth, or seventh decades of life. The mandible was more affected than the maxilla (74.2%). Association of CCOC with impacted teeth was found in 2.4% of cases, thus rendering it a rare occurrence. The present case report corroborates the results of the survey regarding sex and anatomical location of the tumor; however, it contradicts the findings regarding age predilection. The case described is the fourth known occurrence of tooth impaction associated with the tumor and the first in a female. In conclusion, CCOC should be considered, as well as other malignancies, as a possible diagnosis of maxillary or mandibular intraosseous lesions even in unusual circumstances such as in association with impacted teeth and in young patients.
Assuntos
Carcinoma , Neoplasias Mandibulares , Tumores Odontogênicos , Dente Impactado , Adulto , Feminino , Humanos , Neoplasias Mandibulares/diagnóstico , Neoplasias Mandibulares/patologia , Neoplasias Mandibulares/cirurgia , Osteotomia Mandibular/métodos , Tumores Odontogênicos/diagnóstico , Tumores Odontogênicos/cirurgia , Dente Impactado/diagnóstico por imagem , Dente Impactado/patologia , Dente Impactado/cirurgiaRESUMO
Objetivo: o fibroma ossificante trabecular juvenil (FOJT) é uma lesão fibro-óssea incomum, benigna, porém de comportamento agressivo. Ocorre, frequentemente, em crianças e adolescentes, com maior acometimento em maxila e mandíbula. O presente relato aborda os aspectos clínicos, imaginológicos, histopatológicos, imuno-histoquímicos e o tratamento de um caso de FOTJ. Além de discutir suas similaridades com o osteossarcoma de baixo grau e as alternativas para o seu diagnóstico. Relato de caso: paciente do sexo masculino, com 12 anos de idade, apresentando aumento de volume em mandíbula no lado esquerdo, perda de função mastigatória e de fala, com tempo de evolução de seis meses. Radiograficamente, a lesão apresentava aspecto unilocular, com limites definidos e de padrão misto. O tratamento consistiu em cirurgia de enucleação total da lesão, seguida de curetagem sob anestesia geral. A histopatologia e a ausência de marcação para MDM2 e CDK4 na imuno-histoquímica confirmaram o diagnóstico de FOTJ e excluíram o de osteossarcoma de baixo grau. No controle pós-operatório de 20 dias, o paciente relatou melhora da parestesia, da função mastigatória e da fala e ausência de dor. Não se observou recidiva no acompanhamento de 1 ano após a cirurgia. Considerações finais: a similaridade dos aspectos clínico, imaginológico e microscópico entre FOJT e osteossarcoma de baixo grau pressupõe o estudo imuno-histoquímico com os arcadores MDM2 e CDK4, minimizando equívocos no diagnóstico e orientando de forma mais eficiente o plano de tratamento adotado.(AU)
Objective: juvenile Trabecular Ossifying Fibromas (JTOF) are uncommon benign fibro-osseous lesions with a local aggressive behavior. They frequently occur in children and adolescents involving the jaw bones. This report addresses the clinical, imaging, histopathological, and immunohistochemical aspects and the treatment of a case of JTOF. In addition, it discusses similarities between JTOF and low-grade osteosarcomas and alternatives for their diagnosis. Case report: male patient, 12 years old, with a tumor in his left mandible, loss of masticatory function and speech, with a 6-month time course. Radiographically, the lesion had an unilocular aspect, with defined borders and a mixed image pattern. Treatment consisted surgical enucleation, followed by bone curettage, under general anesthesia. Histopathology presented fibrous stroma interspaced with bone trabeculae without signs of cellular malignancy. MDM2 and CDK4 markers in immunohistochemistry, confirmed the diagnosis of JTOF and excluded low-grade osteosarcoma. At the 20-day postoperative follow-up, the patient reported improvement in paresthesia, masticatory function and speech, and the absence of pain. Evaluation 1 year after surgery showed no signs of local recurrence. Final considerations: the similarity of clinical, imaging, and microscopic aspects between JTOF and low-grade osteosarcoma prompts an immunohistochemical study including MDM2 and CDK4 markers in order to improve final diagnosis and guide the treatment plan more efficiently.(AU)
Assuntos
Humanos , Masculino , Criança , Cementoma/patologia , Neoplasias Mandibulares/patologia , Imuno-Histoquímica , Cementoma/cirurgia , Cementoma/diagnóstico , Neoplasias Mandibulares/cirurgia , Neoplasias Mandibulares/diagnóstico , Osteossarcoma/diagnóstico , Diagnóstico DiferencialRESUMO
Objetivo: o mieloma múltiplo é uma neoplasia maligna progressiva de células B, caracterizada pela proliferaçãodesregulada e clonal de plasmócitos na medula óssea. O presente trabalho tem como objetivo descreverum caso clínico de mieloma múltiplo diagnosticado pelo cirurgião-dentista. Descrição do caso: paciente de60 anos, sexo feminino, compareceu à Clínica-escola de Odontologia da Universidade Estadual de Feira deSantana, Bahia, Brasil, cuja queixa principal era: "Tô sentindo uma dor dentro da boca parece que minhaboca soltou". Na história da doença atual, a paciente relatou que há cerca de dois meses, ao mastigar alimentosde consistência dura, observou um estalido e que, a partir de então, a sensação era de uma luxação dearticulação temporomandibular, porém, com uma sintomatologia dolorosa branda. Na história médica, foirelatado que há 3 anos vem apresentando sinais de dor nos ossos, letargia, disfagia, anemia, perda de peso emal-estar crônico. No exame físico extrabucal, foi observado aumento de volume em região de corpo mandibularesquerdo e na clavícula direita. No exame físico intrabucal, foi observado um pequeno aumento devolume na mandíbula do lado esquerdo. Foram solicitados exames de imagem e foi realizada biópsia incisional.Diante do quadro clínico, imaginológico e histológico, chegou-se ao diagnóstico de mieloma múltiplo.Conclusão: é de suma importância conhecer o comportamento clínico epidemiológico do mieloma múltiplo,para que seja realizado um diagnóstico oportuno, abrangente e precoce, com o objetivo de melhorar o prognósticoe a sobrevida do paciente.(AU)
Objective: multiple myeloma is a progressive malignancy of B cells, characterized by unregulated and clonal proliferation of plasma cells in the bone marrow. The present work aims to describe a clinical case of multiple myeloma diagnosed by the dentist. Case description: a 60-year-old female patient attended the Dentistry School of the State University of Feira de Santana, Bahia, Brazil, whose main complaint was: "I feel a pain inside my mouth, it seems that my mouth has loosened". In the history of the current disease, the patient reported that, approximately 2 months ago, when chewing hard food, she noticed a click and that since then the sensation was of a dislocation of the temporomandibular joint, but with mild painful symptoms. In medical history it has been reported that for 3 years it has been showing signs of bone pain, lethargy, dysphagia, anemia, weight loss and chronic malaise. On physical examination, an increase in volume was observed in the region of the left mandibular body and in the right collarbone. On intraoral physical examination, a small increase in volume was observed in the left side of the mandible. Imaging exams were requested and an incisional biopsy was performed. In view of the clinical, imaging and histological picture, the diagnosis of multiple myeloma was reached. Conclusion: it is extremely important to know the epidemiological clinical behavior of multiple myeloma in order to make a timely, comprehensive and early diagnosis, with the aim of improving the patient's prognosis and survival.(AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Mandibulares/diagnóstico , Neoplasias Mandibulares/patologia , Odontólogos , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/patologia , Radiografia Panorâmica , Radiografia Torácica , Tomografia Computadorizada por Raios X , Evolução FatalRESUMO
Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-hodgkin's lymphoma. In oral cavity represents approximately 2% of all malignancies. Case presentation: This report describes a rare mandibular involvement of DLBCL. A 56 year-old man was referred for evaluation of left mandible pain. In the anamnesis, the patient informed to be treating tooth pain in lasting 6 months. On oral evaluation, an intense mobility of the left mandibular second molar and a swelling in posterior left mandible were observed. Computed tomography showed a large osteolytic lesion affecting both mandibular body and ramus. An incisional biopsy was performed and according to histopathological and imumnohistochemical features, DLBCL was diagnosed. The treatment consisted of 8 cycles of R-CHOP and adjuvant radiotherapy. He is asymptomatic after 6 years. Conclusion: This case showed a rare bone presentation of DLBCL and such tumor should be considered as differential diagnosis of osteolytic lesion of the mandible.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Mandibulares/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Diagnóstico DiferencialRESUMO
O carcinoma espinocelular (CEC) representa o tumor mais frequente dentre todos os cânceres da cavidade oral, com uma média de idade de 60 anos e maior ocorrência no sexo masculino. A característica clássica da lesão é de um nódulo endurecida, com sinais e sintomas que se diferem de acordo com a região oral acometida, muitas dessas lesões são indolores, o que pode causar um retardo no diagnóstico e tratamento da doença. Objetivo: relatar um caso clínico de um paciente com CEC em soalho bucal, ressaltando a importância de o cirurgião-dentista reconhecer e diagnosticar essa doença em estágios iniciais. Relato de caso: paciente do sexo masculino, 60 anos de idade, faioderma, tabagista, foi encaminhado para avaliação de lesão indolor em soalho de boca. No exame clínico, observou-se lesão nodular endurecida em soalho de boca com aproximadamente 3 cm de diâmetro, com presença de placas leucoplásicas em sua extensão e associada à ulceração na região de rebordo alveolar. O exame radiográfico panorâmico mostrou reabsorção óssea na região de ulceração. Foram realizadas a biópsia incisional da lesão e a análise histopatológica, em que foi compatível com CEC. O paciente foi encaminhado para tratamento oncológico. Considerações finais: assim, é imprescindível ressaltar a importância de um adequado exame clínico, bem como do diagnóstico precoce destas lesões malignas, favorecendo um bom prognóstico ao paciente.(AU)
Squamous cell carcinoma (SCC) represents the most frequent tumor among all cancers of the oral cavity, with an average age of 60 years and greater occurrence in males. The classic characteristic of the lesion is a hardened nodule, with signs and symptoms that differ according to the affected oral region, many of these lesions are painless, which can cause a delay in the diagnosis and treatment of the disease. Objective: to report a clinical case of a patient with CPB on the oral floor, emphasizing the importance of the dental surgeon in recognizing and diagnosing this disease in early stages. Case report: male patient, 60 years old, phaderoderma, smoker, was referred for painless lesion on the floor of the mouth. On clinical examination, a hard nodular lesion was observed on the floor of the mouth, approximately 3 cm in diameter, with the presence of leukoplastic plaques in its extension and was associated with ulceration in the region of the alveolar ridge. The panoramic radiographic examination showed bone resorption in the ulceration region. Incisional biopsy of the lesion and histopathological analysis were performed, in which it was compatible with CPB. The patient was referred for cancer treatment. Final considerations: thus, it is essential to emphasize the importance of an adequate clinical examination, as well as the early diagnosis of these malignant lesions, favoring a good prognosis for the patient.(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Neoplasias Mandibulares/diagnóstico , Neoplasias Bucais/cirurgia , Carcinoma de Células Escamosas/cirurgia , Radiografia Panorâmica , Neoplasias Mandibulares/cirurgia , Detecção Precoce de CâncerRESUMO
This study reports 2 odontogenic carcinosarcomas, including the clinicopathologic and immunoprofile characteristics of these rare tumors. The first case occurred in a 22-year-old male presenting a bilobular mass involving the gingiva and bone of the premolar region of the left mandible, with paresthesia of the lower lip. Microscopic examination revealed a tumor similar to ameloblastic fibrosarcoma, with atypical mesenchymal cells; however, the odontogenic epithelium also showed atypia. In the second case, a 16-year-old female had a painless, asymptomatic, large intraosseous mandibular lesion. The patient received radiotherapy to treat a rhabdomyosarcoma of the parotid 13 years before. The tumor was composed of atypical spindle cells, positive for vimentin and smooth muscle actin, intermingled with malignant odontogenic epithelium. Both epithelial and mesenchymal components of the tumors showed high index of p53- and Ki67-positive cells. The first case was diagnosed as odontogenic carcinosarcoma possibly originated from an ameloblastic fibrosarcoma, and the second as de novo odontogenic carcinosarcoma possibly caused by previous radiotherapy.
Assuntos
Carcinossarcoma/diagnóstico , Mandíbula/patologia , Neoplasias Mandibulares/diagnóstico , Tumores Odontogênicos/diagnóstico , Biópsia , Carcinossarcoma/patologia , Diagnóstico Diferencial , Feminino , Fibrossarcoma/diagnóstico , Gengiva/diagnóstico por imagem , Gengiva/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Mandíbula/diagnóstico por imagem , Neoplasias Mandibulares/patologia , Mucosa Bucal/diagnóstico por imagem , Mucosa Bucal/patologia , Tumores Odontogênicos/patologia , Radiografia Panorâmica , Rabdomiossarcoma/diagnóstico , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
The purpose of this study was to perform a systematic review of the literature concerning all documented cases of malignant transformation of craniomaxillofacial fibro-osseous lesions (FOLs). Three electronic databases were searched. Data were evaluated descriptively. Kaplan-Meier survival curves were constructed and compared using the log-rank test. A critical appraisal of included articles was performed through the Joanna Briggs Institute tool. A total of 19 studies including 27 patients were selected for data extraction. Twenty-six cases were initially diagnosed as fibrous dysplasia and one as ossifying fibroma. The mean age at the time of malignant transformation was 38.11 years, and the average time from initial diagnosis to malignant transformation was 18.2 years. The male:female ratio was 1:1.2, and the maxilla:mandible ratio was 1.5:1. The histological type of the malignant tumor was predominantly osteosarcoma. Follow-up was available for 21 patients. The 3-year overall survival rate was 51%. Mandible tumors and diagnoses other than osteosarcoma tended to have poor survival rates, but no significant difference was identified. We concluded that between all FOLs, only fibrous dysplasia seems to have a considerable increased risk of malignant transformation. Thus, a regular and long follow-up period is advised.
Assuntos
Fibroma Ossificante/patologia , Displasia Fibrosa Óssea/patologia , Neoplasias Mandibulares/diagnóstico , Osteossarcoma/diagnóstico , Humanos , Taxa de SobrevidaRESUMO
Objetivo: relatar um caso de ameloblastoma unicístico em região anterior de mandíbula, descrevendo os métodos diagnósticos utilizados e o tratamento empregado. Relato de caso: paciente do gênero feminino, com 40 anos de idade, compareceu ao serviço de Cirurgia e Traumatologia Bucomaxilofacial da Faculdade de Odontologia da Universidade Federal da Bahia, com queixas de aumento de volume em região anterior de mandíbula, com evolução de 10 meses. O exame de imagem revelou lesão unilocular extensa que expandia cortical óssea em região de mento. Optou-se pela biópsia excisional da lesão, sob anestesia geral. O exame do espécime obtido confirmou o diagnóstico de ameloblastoma unicístico, para o qual se decidiu pela manutenção da terapêutica inicial. A paciente segue em acompanhamento pela equipe, sem sinais de recidivas. Considerações finais: o manejo do ameloblastoma unicístico, por vezes, demanda a biópsia excisional da lesão, a fim de diferenciá-la dos cistos odontogênicos e de individualizar seu padrão histológico. A abordagem conservadora pode ser adotada, desde que um acompanhamento rigoroso seja procedido. (AU)
Objective: to report a case of unicystic ameloblastoma in the anterior region of the mandible, describing the diagnostic methods used and the treatment applied. Case report: a 40-year-old female patient attended the Oral and Maxillofacial Surgery and Traumatology Service of the School of Dentistry at the Federal University of Bahia, Brazil, complaining of increased volume in the anterior region of the mandible, with a 10-month evolution. Imaging tests revealed extensive unilocular lesion that expanded the cortical bone in the mental region. Excisional biopsy of the lesion was performed under general anesthesia. The examination of the specimen obtained confirmed the diagnosis of unicystic ameloblastoma, for which it was decided to maintain the initial therapy. The patient is still being followed-up by the team, with no signs of relapses. Final considerations: the management of unicystic ameloblastoma sometimes requires excisional biopsy of the lesion to differentiate it from odontogenic cysts and isolate its histological pattern. The conservative approach may be adopted if along with strict monitoring. (AU)