Paulo De Camargo Moraes

Metastatic Adenocarcinoma of the Colon: Early Manifestation in Gingival Tissue

A case of gingival metastasis of adenocarcinoma of the colon is reported, the lesion being an early clinical indication of a primary malignant tumor. The diagnosis of metastatic lesion in the oral region is always challenging, both to clinician and to the pathologist, due to its rarity and complexity. In the present case, the clinical hypothesis was peripheral ossifying fibroma or pyogenic granuloma. Histologically, the biopsy tissue revealed a malignant neoplasm not connected to the mucosal surface. Immunohistochemically, the lesion was positive for 35ßH11 and cytokeratin 20 and focally positive for cytokeratin 7. Treatment involved excision of primary tumor and follow-up chemotherapy. The clinical, histological and immunohistochemical characteristics are discussed.

Cryosurgery as an Effective Alternative for Treatment of Oral Lesions in Children

Children can exhibit a wide variety of oral pathologies, such as oral lesions, bone lesions, tumors, cysts and cutaneous lesions. Different techniques have been described for the treatment of these lesions, but all of them are invasive. This paper presents a series of cases that demonstrate the clinical efficacy of cryosurgery as an alternative to invasive surgical treatments of the most common oral lesions in children. This technique has been well tolerated by patients due to the absence of anesthesia, rapid healing and minimal bleeding. Cryotherapy has many applications in oral medicine and is an extremely useful alternative in patients to whom surgery is contraindicated due to age or medical history. It is a simple procedure to perform, minimally invasive, low-cost and very effective in pediatric dentistry clinic.

Gardner syndrome with no clinical family history.

Gardner syndrome, a variant of familial adenomatous polyposis, is a hereditary disorder inherited as an autosomal dominant with high penetrance and variable expression that is caused by a mutation of the adenomatous polyposis coli gene. It is characterized by gastrointestinal polyps associated with multiple osteomas, dental anomalies, skin and soft tissue tumors, and congenital hypertrophy of the retinal pigment epithelium. Early diagnosis of Gardner syndrome is crucial and may be life saving because the polyps usually undergo malignant change by the fourth decade of life. The extraintestinal manifestations frequently precede gastrointestinal symptoms; consequently, the dentist may play an important role in the diagnosis of this syndrome. The authors report a case of Gardner syndrome with no clinical family history that was diagnosed by the dentist based on oral and maxillofacial findings.

Recurrent oral pyogenic granuloma in port-wine stain.

Pyogenic granuloma (PG) is a benign inflammatory lesion, nonneoplastic in nature, which occurs in the oral cavity and skin. This lesion arises in response to various stimuli such as low-grade local irritations, traumatic injury, or hormonal factors. Recently, in some cases, the occurrence of recurrent PGs in skin associated with vascular lesions, such as port-wine stains, has been described. It has been postulated that this association is promoted by arteriovenous anastomoses in the vascular lesions, leading to the development of PG. The authors discuss 2 cases of recurrent PG in patients with a port-wine stain, and the treatment options adopted.

Peripheral odontogenic fibroma: an uncommonly overviewed lesion.

Peripheral odontogenic fibroma is considered a gingival tumor characterized by a proliferation of relatively cellular fibrous or fibromyxomatous connective tissue which exhibits variable amounts of odontogenic epithelium and sometimes foci of calcification in the form of dentinoid, cementicles, or bone. It is considered the extraosseous counterpart of central odontogenic fibroma. This lesion usually is presented as a focal swelling in the gingiva, occurring in a wide age range, and the anterior region of the gingiva is the most frequent anatomic site. Conservative local excision is the treatment frequently adopted and its recurrence rate varies widely, and its biologic behavior is still unknown. In this study, the authors discuss 3 cases of peripheral odontogenic fibroma, and present their clinical and histopathological features and management.

Successful in a conservative treatment of osteoradionecrosis of the jaw: a case report and review of literature

Osteoradionecrosis of jaws is one of the most serious complications of radiation therapy for head and neck malignancies. The management of osteoradionecrosis continues to be debated and there are few cases which can be resolved with conservative management. This paper presents a case of osteoradionecrosis after a dental extraction affecting the mandible of a 58-year-old man and highlights the conservative therapeutic management and 3-year follow-up period. We combined a conservative nonoperative therapy, including long-term antibiotic therapy and daily irrigation with chlorhexidine mouthrinses in a case of osteoradionecrosis after a dental extraction affecting the mandible of a 58-year-old man. At the follow-up, clinical aspect was resolved. A CBCT scan image and a three-dimensional (3D) reconstructed image revealed bone remodeling in a 3-year follow-up period .No sign of exposed bone could be seen. Follow-up 3 years later revealed that the conservative management posed was successful for osteoradionecrosis and the patient is currently under regular review.

Extramedullary Plasmacytoma Diagnosed in an HIV-Positive Patient by an Unusual Clinical Presentation

The aim of this paper is to describe a case report of EMP in an HIV-positive patient. A 44-year-old, dark-skinned HIV-infected woman was referred to the Oral Diseases Treatment Center with a swelling at palate and left gingival fornix in the maxilla. Biopsy was taken and the oral lesion was diagnosed as EMP with well-differentiated plasma cells and restriction of the lambda light-chain. Skeletal survey was performed and no radiograph alterations were observed, thus supporting the diagnosis of EMP. Patient was referred to treatment and after two months of chemo and radiotherapy, an expanding lesion was observed in L5/S1 patients vertebrae. Biopsy of the spinal lesion was consistent with lymphoma with plasmocitary differentiation, supporting the diagnosis of multiple myeloma (MM). Regarding the medical history, the final diagnostic was an oral extramedullary plasmacytoma with rapid progression into multiple myeloma. It is crucial to emphasize the relevance of HIV infection as a risk factor for both aggressive clinical behavior and unusual clinical presentation of extramedullary plasmacytoma cases.

Sialolithiasis of minor salivary glands

Sialolithiasis, or salivary calculus, is a disease of the salivary glands, characterized by the formation of mineralized structures within the excretory salivary ducts or the glandular parenchyma. Approximately 80% occur in the submandibular gland, followed by the parotid and sublingual glands. Although rare, sialolithiasis can also occur in the minor salivary glands. Although the oral cavity and upper lip are the most common sites, they can develop in any region of the oral cavity that contains minor salivary glands. Treatment is based on surgical excision of the lesion, with a favorable prognosis. This study presents three cases of sialolithiasis of minor salivary glands of the upper and lower lip, addresses their clinical characteristics and correlation with microscopic findings, diagnosis and treatment plans. Etiology and factors that should be considered during diagnosis, appropriate treatment and improved prognosis are discussed in this study.

Cuidados pré, trans e pós operatórios em pacientes com insuficiência renal crônica (IRC): Relato de caso

Com o aumento da sobrevida do ser humano, aumentou o numero de idosos e consequentemente, de pessoas com diversas doencas sistemicas. Uma delas e a insuficiencia renal cronica, a qual apresenta um alto indice de alteracoes sistemicas e pode afetar significativamente a conduta terapeutica. Alem disso, a perda das funcoes de equilibrio hidro-eletrolitico e excretora dos rins pode causar manifestacoes orais e multiplas complicacoes, os quais devem refletir na conduta do cirurgiao dentista para o tratamento odontologico. Anomalias sistemicas, como a anemia, disturbios de plaquetas e hipertensao, bem como acometimentos orais, tais como xerostomia, acumulo de calculo dental, estomatite uremica e infeccoes por Candida sp sao observados no paciente renal cronico. Principalmente nesses casos e importante a manutencao da saude bucal, visto que esses pacientes sao candidatos em potencial ao transplante renal. Desta forma, o objetivo deste trabalho e apresentar um caso clinico de um tratamento odontologico de um paciente com insuficiencia renal cronica, buscando orientar o clinico quanto aos cuidados necessarios, desde orientacoes pre, trans e pos-operatorias, esclarecimento dos aspectos mais importantes sobre a doenca e cuidados relacionados a prescricao medicamentosa. Palavras-chave: Hemodialise; Insuficiencia renal cronica; exodontia.