Alessandra Dutra da Silva

Tufted Angioma in Children: Report of Two Cases and a Review of the Literature

Tufted angioma (TA) is a benign vascular tumor with endothelial origin. It is extremely rare in oral mucosa; only seven cases have been reported in the literature so far. Here, we describe two cases of tufted angioma observed in children and we also present a review of the literature about this pathology, concerning the differential diagnosis and management of this lesion in children.

Ameloblastic neoplasia spectrum: a cross-sectional study of MMPS expression and proliferative activity.

OBJECTIVE To compare the proliferation and the expression of matrix metalloproteinases (MMPs; MMP-2 and MMP-9) in solid and unicystic ameloblastomas with ameloblastic carcinomas. STUDY DESIGN Five cases of ameloblastic carcinoma (AC), 18 cases of solid ameloblastoma (SA), and seven of unicystic ameloblastoma (UA) were selected. The immunohistochemical expression of MMPs was assessed by the percentage of positive tumor cells and stained stroma. The mean argyrophilic nucleolar organizer region (AgNOR) and the percentage of cells with more than one AgNOR per nucleus were evaluated. RESULTS Statistically significant higher mean AgNOR was observed in AC than in SA and UA. MMP-2 was expressed similarly in tumor and stroma among groups. MMP-9 was higher in the stroma of SA than that of UA (P = .0484). CONCLUSIONS The cell proliferation was related to the greater aggressiveness of AC. High expression of MMP-2 and MMP-9 in all lesions highlighted the importance of these enzymes in the biology of ameloblastic tumors.

Slow-growing mass and expansive swelling in the maxilla

CLINICAL PRESENTATIONA 40-year-old white man was referred to the oralmedicine clinic with the chief complaint of pressure inthe region from where the right maxillary first molarhad been extracted. The patient presented with diffuseswelling of the right maxilla that had persisted throughthe past year and had worsened during the 6 monthspreceding his admission to our clinic. The patient hadalso experienced trauma to the maxillary right centralincisor, which required endodontic treatment. The pa-tient was a woodworker, and his medical history wasnot informative. He reported a history of smoking,regular alcohol consumption, and occasional use ofmarijuana.Extraoral examination revealed fixed cervical lymphnodes that were enlarged and asymptomatic on palpa-tion. The right side of his face was slightly asymmetricwithout inflammation of the skin. Intraoral examinationrevealed a swelling with undefined borders, measuringapproximately 6.0 5.5 3.2 cm. The lesion extendedfrom the right upper incisor to the right second molar,was firm on palpation, and caused cortical plateexpansion, as well as displacement and mobility of theright maxillary premolars. The color and surface of thecovering mucosa were clinically normal except forsome red punctate areas that drained blood underpressure. Further, the maxillary right central incisor,which required endodontic treatment, showed coronaldiscoloration, suggesting pulp necrosis (Figures 1Aand 1B).A panoramic radiograph showed an ill-definedradiolucency in the region of the first right maxillarymolar, opacification of the antrum, and disruption of itsfloor. In addition, a well-defined radiolucency of 3 cmdiameter with sclerotic margins was present in theanterior region of the maxilla, consistent with aradicular cyst (Figure 2). A periapical radiographrevealed radiolucency with borders that had a moth-eaten appearance in the region of the first molar. Thelesion involved the periradicular portions of the adja-cent teeth, which presented no signs of dental rootresorption (Figure 3).DIFFERENTIAL DIAGNOSISThe clinical presentation, radiographic findings, andthe vitality of all the adjacent teeth excluded thepresence of inflammatory lesions. An expansiveintraosseous mass causing tooth displacement andbone destruction suggested an aggressive neoplasticprocess. Therefore, we considered squamous cellcarcinoma of the maxillary sinus, malignant salivarygland tumor (e.g., adenoid cystic carcinoma, mucoe-pidermoid carcinoma) and lymphoma as the maindifferential diagnoses. Further, the presence of abenign, locally aggressive odontogenic tumor, suchas a keratocystic odontogenic tumor (KOT) or amyxoma, was possible. Non-neoplastic lesions, suchas a central giant cell lesion or an aneurysmal bonecyst, could also display the features of this patient’slesion.A swelling with aggressive behavior suggested thepossibility of a malignancy that originated in themaxillary sinus. Among those tumors, squamous cellcarcinoma of the maxillary sinus (SCCMS) is one of themost frequent. Although its symptoms are nonspecific,the most common manifestation is facial swelling, fol-lowed by epistaxis and nasal obstruction that resemblesinusitis.