Francisco Jadson Lima

Epithelial-Myoepithelial Carcinoma of High Grade Transformation: The Case Report in the Buccal Mucosa

Epithelial-myoepithelial carcinoma was first described by Danath et al. in 1972 and is classified as a rare low-grade biphasic neoplasm of the salivary glands. This case report presents a male patient who had a lesion in the oral mucosa with a history of recurrence of the tumor. The outcome resulted in a profile consistent with an epithelial-myoepithelial carcinoma with a high degree of transformation. The case highlights the importance of histopathological evaluation of oral lesions, which occasionally may not present typical clinical aspects of malignant lesion.

A Rare Case of Intraoral Nodular Fasciitis: Diagnosis and Immunohistochemical Profile

Nodular fasciitis is a benign, idiopathic, reactive proliferation of myofibroblasts found in the subcutaneous fascia; intraoral occurrence is very rare. An 18-year-old woman was referred to the oral diagnosis service with a 1-month history of a nodular mass in the gingiva. Clinical examination disclosed a well-circumscribed, mobile, pedunculated mass in the left mandibular gingiva. The clinical diagnoses included pyogenic granuloma. She underwent an excisional biopsy under local anesthesia through an intraoral approach. Microscopic examination showed a proliferation of spindle cells arranged in intersecting fascicles. The spindle cells exhibited plump, vesicular nuclei without significant pleomorphism. Scattered multinucleated giant cells also were present. Immunohistochemical stains showed that the lesional cells were positive for smooth muscle actin and vimentin and negative for S-100 protein. The features were those of an inflammatory, benign myofibroblastic lesion, consistent with intraoral nodular fasciitis.

Orthokeratinized odontogenic cyst associated with multinucleated giant cell reaction: report of unusual findings

Orthokeratinized odontogenic cysts are developmental odontogenic cysts, presenting with low frequency, low rate of recurrence and their ethiopathogenesis is unknown. Radiographically, they show a radiolucent area in the mandibular posterior region. The aim of this report is to describe an unusual case of orthokeratinized odontogenic cysts, radiographically exhibiting radiopaque areas with an aspect of calcifications in the lesion. Based on this, the clinical hypothesis of ameloblastic fibro-odontoma was suggested. After incisional biopsy and microscopic analysis, the conclusive diagnosis was orthokeratinized odontogenic cysts. The radiopaque foci were observed to be associated with a foreign body reaction. The patient was submitted to surgery under local anesthesia, with intraoral access for complete excision of the lesion and to re-establish esthetics. After follow-up of 24 months there were no signs of recurrence. Knowledge of this type of reaction is important because of the risk that the lesion may mimic a potentially more aggressive lesion, affecting the choice of treatment. Indexing terms: Giant cells. Odontogenic cysts. Pathology.

Hyaline ring granuloma of vegetable: Report of two cases with histochemical and immunohistochemical study.

BACKGROUND Peripheral hyaline ring granuloma is a rare lesion characterized by the presence of hyaline rings and multinucleated giant cells. Its pathogenesis is related to exogenous factors such as vegetal origin, resulting in foreign body reaction mediated by macrophages against cellulose particles. We report two cases: a 58-year-old male with a lesion in the maxillary alveolar mucosa measuring 1.0cm×1.0cm; and a 50-year-old female presenting a slight swelling in the alveolar mucosa, measuring 0.7cm×0.7cm and diagnosed as asymptomatic sessile nodule of fibrous consistency. Microscopic examination revealed a dense connective tissue with focal area of concentric hyaline collagen deposition and multinucleated giant cell granulomas of foreign body type. Immunohistochemical study was positive for anti-CD68/anti-α-SMA, confirming the foreign body reaction and vascular integrity. Histochemical analysis for PAS with and without diastase and van Gieson highlighted the vegetable exogenous origin of foreign material. Additionally, we performed a review of 7 cases published in the literature in the last 10 years.