Oral lesions of systemic lupus erythematosus: A collaborative Latin American study

BACKGROUND

Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease that may affect the oral mucosa. The variable spectrum of oral lesions observed in SLE can pose challenges in diagnosis, particularly when the lesions occur in isolation. The aim of this study was to describe the oral lesions occurring in patients with SLE from Latin America.

METHODS

This collaborative record-based study involving 11 oral and maxillofacial pathology and medicine services across Venezuela, Argentina, Chile, Brazil, and Mexico describes the clinicopathological profile of SLE-related oral lesions.

RESULTS

Seventy patients with SLE and oral lesions were included in the study. The majority were females (75.7%; female/male ratio: 3.1:1) and white (62.1%), with a mean age of 38.4 years (range: 11-77 years). The most common site of oral lesions was the hard/soft palate (32.0%). Clinically, oral lesions predominantly presented as ulcers (26.6%), erosions (26.6%), and white lesions (23.4%). Isolated oral lesions occurred in 65.2% of individuals, while cutaneous manifestations occurred in 80.3%. The main clinical diagnostic hypothesis in 71.4% of cases was an immune-mediated disease. Oral biopsies followed by histopathological analysis were performed in 50 cases.

CONCLUSION

Oral lesions of SLE exhibit a variety of clinical and histopathological features. A key point in diagnosis is that unusual oral changes without an obvious local cause may indicate a possible systemic condition presenting with oral lesions. A multidisciplinary approach, which includes regular oral examination, is warranted to identify oral lesions and provide treatment.

Squamous Odontogenic Tumor in the Posterior Region of Maxilla

Squamous odontogenic tumor (SOT) is a rare benign but locally infiltrative tumor often misdiagnosed as other entities, such as ameloblastoma and squamous cell carcinoma, due to overlapping morphological findings. We document here the clinicopathological and imaging findings of an aggressive intraosseous SOT in the posterior left region of the maxilla in a 25-year-old male patient. On intraoral examination, the tumor extended from the region of the left lateral incisor to the upper left premolar and was covered by reddish mucosa, with discrete areas of ulceration. Imaging exams revealed an osteolytic lesion causing thinning, erosion, and buccal and lingual cortical plate perforation associated with an impacted canine. Microscopically, the tumor showed a proliferation of islands of well-differentiated squamous epithelium in a variably collagenized background. The peripheral cells of the islands were flat or slightly cuboidal and did not exhibit nuclei with peripheral palisade and reverse polarization. The diagnosis of SOT was rendered. The patient underwent surgical resection and has been under clinical follow-up for approximately 12 months with no signs of recurrence. A careful morphological evaluation is essential to avoid misdiagnosis and ensure a satisfactory treatment approach.

Acquired oral syphilis: A multicenter study of 339 patients from South America

OBJECTIVE

To report the clinicopathologic features of acquired oral syphilis cases in South American countries.

MATERIALS AND METHODS

Clinical data were retrospectively collected from the records of 18 oral diagnostic services in Argentina, Brazil, Chile, Colombia, Venezuela, Uruguay, and Peru. Serologies of nontreponemal and treponemal tests were used for diagnosis.

RESULTS

The series comprised 339 cases of acquired oral syphilis. Secondary syphilis ranked as the most common stage (86.7%). Lesions were more frequent among males (58.0%) and young adults with a mean age of 33.3 years. Individuals aged 20-29 years were most affected (35.3%). The most commonly involved sites were the tongue (31.6%), lip/labial commissure (25.1%), and hard/soft palate (20.4%). Clinically, acquired oral syphilis usually presented as mucous patches (28.4%), papules (25.7%), and ulcers (18.1%). Skin manifestations occurred in 67.7% of individuals, while lymphadenopathy and fever were observed in 61.3% and 11.6% of all subjects, respectively. Most patients were treated with the benzathine penicillin G antibiotic.

CONCLUSION

This report validates the spread of acquired oral syphilis infection among young adults in South America. Our directives include accessible diagnostic tools for proper disease screening, surveillance, and counselling of affected individuals, especially in low- and middle-income countries.

Oral Juvenile Xanthogranuloma: A Clinicopathological, Immunohistochemical and BRAF V600E Study of Five New Cases, with Literature Review

Juvenile xanthogranuloma (JXG) is the most common form of non-Langerhans cell histiocytosis and oral mucosal involvement is exceedingly rare. Histiocytic disorders harbor activating mutations in MAPK pathway, including the report of BRAF V600E in JXG of extracutaneous site. However, no information is available for oral JXG. Herein, the clinicopathological and immunohistochemical features of five new oral JXG were evaluated in conjunction with literature review. Also, we assessed the BRAF V600E in oral samples. Five oral JXG were retrieved from pathology archives. Morphological and immunohistochemical analyses were performed. The BRAF V600E status was determined with TaqMan allele-specific qPCR. The series comprised of three female and two male patients, most of them adults, with a median age of 39 years (range 13-68 years). Clinically, the lesions appeared as asymptomatic solitary nodules, measuring until 2.5 cm, with more incident to the buccal mucosa. Morphologically, most of the cases presented classical histological features of JXG, with histiocytic cells consistent with the non-Langerhans cell immunophenotype. BRAF V600E was not detected in the cases tested. This is the first and largest published series of oral JXG affecting adults and a Brazilian population. The molecular pathogenesis of oral JXG remains unknown. Clinicians and pathologists must recognize JXG to avoid misdiagnoses with oral benign or malignant lesions.

Kawasaki Disease Associated with Covid-19 in a Pediatric Patient

Kawasaki disease (KD) is a multisystemic vasculitis of small and medium-size vessels that mainly affects children under five years of age. The etiology of KD is still uncertain; however, evidence suggests that infectious agents and genetic susceptibility act as a trigger for its development, which could explain the increase in cases of children with COVID-19 who developed a classic or incomplete form of KD. The aim of this report is to discuss a case of a five-year-old boy diagnosed with incomplete KD associated with COVID-19.

Mature T/NK-Cell lymphomas of the oral and maxillofacial region: A multi-institutional collaborative study

BACKGROUND

The diagnosis of oral and maxillofacial mature T/NK-cell neoplasms is challenging because of their rarity, morphological heterogeneity and complex immunophenotype with scarce available data describing their clinical and microscopic aspects. Therefore, in this study, we investigated a series of mature T/NK-cell neoplasms affecting this anatomical region and provided an updated literature review.

METHODS

Cases diagnosed as mature T/NK-cell lymphomas affecting the oral and maxillofacial region were retrospectively retrieved from six pathology files and their diagnoses were confirmed using haematoxylin and eosin-stained slides, immunohistochemical reactions and in situ hybridization for Epstein-Barr virus (EBV) detection. Patients' clinical data were collected from their pathology forms.

RESULTS

A total of 22 cases were included in this study. Eleven (50%) consisted of extranodal NK/T-cell lymphomas, nasal type; eight (36.4%) were peripheral T-cell lymphomas, NOS; two (9.1%) were adult T-cell leukaemia/lymphomas, and one (4.5%) was an ALK-positive anaplastic large cell lymphoma. Overall, males predominated, with a mean age of 55.7 years. The palate was the most affected site (50%), and tumours usually presented as destructive and painful ulcers. EBV was present in all cases of extranodal NK/T-cell lymphoma nasal type but was absent in the other subtypes.

CONCLUSION

Among mature T/NK-cell lymphomas of the oral and maxillofacial region, extranodal NK/T-cell lymphoma, nasal type and peripheral T-cell lymphoma, NOS predominated. Older men were the most affected patients, and this heterogeneous group of neoplasms has a very aggressive clinical behaviour.

Nasolabial cyst in an elderly patient: A case report

INTRODUCTION

Nasolabial Cyst (NC) or Klestadt's cyst is a relatively rare soft tissue developmental lesion of nasal alar region accounting for 0.7% of all non-odontogenic cysts. NC usually presents as an asymptomatic swelling located in the anterior region of the maxilla lateral to midline-resulting in obliteration of nasolabial sulcus, nasal vestibule and maxillary labial sulcus and facial asymmetry-often observed on early stages by most patients due to cosmetics issues.

CASE REPORT

A 76-year-old woman was referred for evaluation of an asymptomatic facial swelling in the left upper lip region lasting 20 years. Extraoral clinical examination showed a left-sided swelling lateral to midline near to the alar base resulting in facial asymmetry. Intraoral clinical examination revealed the presence of a single painless well-defined nodular, sessile, non-tender swelling covered by normal oral mucosa, and located in the upper labial mucosa in the left incisor's region. An excisional biopsy was performed, and microscopic examination revealed a cystic cavity lined by cuboidal to columnar epithelium with mucous cells. The underlying connective tissue showed chronic inflammatory infiltrate close to muscular tissue. Patient recovery was uneventful, and there are no signs of local recurrence in a 2-year clinical follow-up.

CONCLUSION

Clinicians should consider NC when evaluating an upper lip swelling extending to the nasolabial region of the elders.

A Contribuição da Odontologia no Diagnóstico e Manejo da Síndrome de Sturge-Weber: Relato de dois Casos

Objetivo: O objetivo deste estudo foi relatar dois casos de pacientes do sexo feminino com diagnóstico de síndrome de Sturge-Weber (SSW), suas principais manifestações clínicas orais e maxilofaciais e tratamento odontológico. Relato de caso: Caso 1. Paciente do sexo feminino, 30 anos, encaminhada à Clínica de Estomatologia da Universidade Estadual do Rio de Janeiro para avaliação de lesão avermelhada difusa no rosto e na boca. Durante o exame clínico, foram detectadas manchas de vinho do porto (MVP) no lado direito da face e descoloração intraoral sugestiva de SSW. Como a paciente não referia sintomas, foi encaminhada a uma equipe de neurologia para investigar alterações no sistema nervoso central (SNC). Caso 2. Uma mulher de 19 anos foi encaminhada para avaliação de um sangramento gengival com duração de 5 meses na mucosa alveolar mandibular e maxilar direita. O exame extraoral mostrou a presença de MVP no lado direito do rosto. Ao exame intraoral, a hiperplasia gengival causou má oclusão, deposição de placa e sangramento grave. O diagnóstico de SSW foi estabelecido devido a esses achados. A paciente foi encaminhada para tratamento periodontal. Conclusão: Dessa forma, é essencial que o dentista tenha conhecimento das manifestações clínicas dessa síndrome, a fim de realizar seu diagnóstico e propor o tratamento correto

Abordagem Conservadora de um Ameloblastoma Unicístico um um Paciente Jovem - Relato De Caso

Objetivo: O objetivo desse trabalho foi relatar o sucesso de um caso de ameloblastoma unicístico tratado conservadoramente. Relato de caso: Paciente do gênero masculino, 12 anos de idade, se apresentou para consulta na clínica de Estomatologia com queixa principal de assimetria facial e abertura bucal limitada. Ao exame clínico extraoral observou-se aumento de volume facial expressivo no lado esquerdo. Ao exame intraoral, foi observadao aumento de volume e apagamento do fundo de vestíbulo na região posterior esquerda de mandíbula. Na radiografia panorâmica foi observada uma lesão radiolúcida unilocular e osteolítica comprometendo corpo, ângulo e ramo de mandíbula, deslocando superiormente o dente 38. Na tomografia computadorizada, foi observada a expansão das corticais vestibular e lingual. Diante desses achados as hipóteses diagnósticas foram: Cisto Dentígero; Ameloblastoma Unicístico e Fibroma Ameloblástico. Foi realizada biópsia incisional que estabeleceu o diagnóstico definitivo de ameloblastoma unicístico. O paciente foi submetido à marsupialização, e nove meses depois, à enucleação. Após sete anos de acompanhamento clínico, o paciente encontra-se livre da doença. Conclusão: O tratamento cirúrgico conservador para o ameloblastoma unicístico deve ser indicado em pacientes jovens, com objetivo de se evitar um procedimento mutilador.

Clinical and Histopathological Evaluation of Photodynamic Therapy Associated with The Low-Level Laser Therapy on Patients with Actinic Cheilitis - A Six-Month Follow-Up Trial

O objetivo do presente estudo foi avaliar a eficácia clínica e histopatológica da terapia fotodinâmica (TFD) associada à terapia a laser de baixa potência no tratamento de pacientes com queilite actínica (QA) após seis meses de acompanhamento. Material e Métodos: pacientes com QA ativa foram submetidos a duas sessões de TFD associadas à laserterapia de baixa potência, utilizando o 5-aminolevulinato de metila como droga fotossensibilizadora. Após seis meses de acompanhamento, uma nova biópsia incisional foi realizada para avaliar a resposta ao tratamento. Resultados: excelentes taxas de eficácia foram observadas na melhora dos sintomas neste estudo, no entanto, a análise histopatológica não foi tão promissora e apenas a melhora do grau de displasia só pode ser observada em 20% da amostra. Conclusão: de acordo com os resultados do presente estudo, pode-se concluir que a terapia fotodinâmica associada à laserterapia de baixa potência parece ser uma opção a ser considerada no tratamento da Queilite Actínica. No entanto, os pacientes devem ser acompanhados de perto clinicamente e, eventualmente, histopatologicamente

Oral Juvenile Xanthogranuloma: Report of Two Cases

Juvenile xanthogranuloma is a rare non-Langerhans cell histiocytosis that usually occurs in the skin of children. Extracutaneous involvement is rare, and few cases affecting the oral cavity have been reported. The purpose of the present study was to report two cases of oral juvenile xanthogranuloma affecting the lower lip of a 14-year-old girl and the soft palate of a second 14-month-old girl, both present as yellowish papules. The lesions were surgically excised, and histological and immunohistochemical analysis showed a proliferation of non-Langerhans cells histiocytes and foamy cells, fulfilling the morphologic features of juvenile xanthogranuloma. The patients have been followed up, respectively, for 36 and 49 months with no signs of recurrence. Based on these results, juvenile xanthogranuloma should be included in the differential diagnosis of oral yellowish soft-tissue swellings in children and adolescents and should be managed through conservative surgical excision.

Intraoral nerve sheath myxoma: case report and systematic review of the literature

BACKGROUND

Oral nerve sheath myxoma (NSM) is an uncommon benign neoplasm with Schwann-cell origin, which is frequently mistaken for neurothekeoma. We report a case of NSM on the buccal mucosa in a 42-year-old woman. This case is compared with previously reported cases and a systematic review is performed.

METHODS AND RESULTS

We conducted a case report and systematic review of oral cases considered true NSMs. A literature search was performed using PubMed, Lilacs, Scielo, Cochrane, SciVerse Scopus, Web of Science, and Embase electronic database. Twenty-five cases of oral NSM were included in the systematic review.

CONCLUSION

Oral NSM is rare and may represent a diagnostic challenge for pathologists. To confirm the diagnosis of NSM, the evaluation of S-100 protein expression or other neural marker is essential. The use of the terms NSM and neurothekeoma as synonymous or as variants of the same tumor should be avoided, because they are clearly distinct lesions.

Bilateral adenomatoid odontogenic hamartoma

We report the first case of bilateral odontogenic lesions consistent with several cases of unifocal adenomatoid odontogenic hamartoma in the literature. The lesions were well circumscribed, unilocular, radiolucent, and located in the region of the third mandibular molar region in a 12-year-old female patient. The lesions were composed of odontogenic hard and soft tissues, dental papilla, dentin, enamel matrix, and adenomatoidlike odontogenic epithelium. The lesions were enucleated with no recurrence at 6 months.

Prevalence of oral hairy leukoplakia in 120 pediatric patients infected with HIV-1

Oral hairy leukoplakia (OHL) is an EBV (Epstein-Barr virus) opportunistic infection found in HIV-infected patients. It is an asymptomatic lesion that has an important prognostic value in AIDS. Differently from what takes place with HIV adult patients, OHL has been described in the literature as having a very small prevalence in pediatric patients. Therefore, the aim of this study was to investigate the prevalence of OHL in HIV pediatric patients using cytopathology. The sample consisted of 120 patients who were submitted to oral examination and had material scraped from both sides of their tongues. The diagnostic criterion was based on the identification of nuclear alterations. Clinical OHL was identified in two (1.67%) patients. The cytopathology revealed twenty (16.7%) cases of subclinical OHL. Our results show that in pediatric patients the prevalence of OHL may be larger than that described in the literature.

Electromagnetic radiation--parameters for risk assessment

The assessment of human exposure to electromagnetic radiation (EMR) under occupational and environmental conditions is one of the most complicated problems of public health science and practice. The problems arise from the very essence of EMR, the conflicting requirements of the measuring instruments, the complexity of electromagnetic waves in the working environment, and the still unknown mechanisms of their biological effects. One of the best ways to develop methods and criteria for exposure assessment of EMR is to determine the electromagnetic field parameters as well as those related to the quantity of energy absorbed by the organism. Definitions have been given mainly regarding tissues' electric and magnetic characteristics, and regarding the energetic parameters of EMR, without description of concrete methods of exposure assessment in different complicated cases of wide-ranging impulsive, non-homogeneous radiation. The best parameters for exposure assessment are the Specific Absorption Rate (SAR), the energetic loading of the human body (the electromagnetic dose W), the time-weighted average (TWA), using time-dependent hygienic norms and standards.

An investigation of a possible humoral factor produced by the thymus in terms of its effect on immunological competence

Four to six week old neonatally thymectomised mice given syngeneic homografts of neonatal thymus gained weight normally and produced a normal number of spleen cells capable of haemolysing sheep erythrocytes. Syngeneic newborn thymus grown in tissue culture for up to 9 days and then grafted similarly prevented neonatally thymectomised mice developing wasting disease and tended to restore the number of immunological competent spleen cells to normal. Repeated injections of fluid in which such thymuses had been grown in tissue culture failed, however, to affect neonatally thymectomised mice. They lost weight, suffered from wasting disease, and their antibody producing spleen cells were as diminished in number as those of untreated thymectomised controls. Most thymectomised mice given repeated injections of an aqueous extract of mouse thymus were similarly unaffected but a few of them gained weight and a few developed an increased number of spleen cells producing sheep haemolysins. Neonatal thymus enclosed in “Millipore” diffusion chambers implanted into neonatally thymectomised mice underwent early necrosis. The seals of most of the chambers broke down, and then on some occasions there was weight gain or an increase in number of immunologically competent spleen cells. It was possible that some thymus tissue may have escaped from the chamber and become a true homograft in the peritoneal cavity.

It was concluded from these experiments that the part played by the thymus in developing the immune response in newborn animals was not mediated by an obvious humoral factor but the interaction between thymus and immature lymphocyte takes place at a more intimate level.