Roberta Rezende Rosa

Heterotopic Gastrointestinal Mucosa of the Tongue

Figure 1. Nodular mass located on the midline of the dorsum of the tongue, with color similar to adjacent mucosa. It was pedunculated and firm on palpation. A 2-year-old girl was referred for evaluation of a painless tumor on the tongue, which developed soon after birth. On examination, the lesion was a pedunculated 1 cm nodule located at the midline of the dorsum of the tongue, anterior to circumvallate papillae (Figure 1). Complete excision under general anesthesia revealed a solid nodule. Microscopically, the ordinary stratified squamous nonkeratinized epithelium was abruptly replaced by simple columnar epithelial cells organized in foveolar structures extending to the full depth of the lamina propria (Figure 2; available at www.jpeds.com). The epithelium near the surface was more cellular and depicted mild atypia, and deeper cells were clearly mucous, periodic acid-Schiffpositive, with bland aspect. The lamina propria was formed by fibrous tissue with intense inflammation near the surface. Distinct spindle cells surrounded the deeper extremities of the foveolar structures. Immunohistochemical reactivity was observed for CK8 and CK19 at the superficial aspect of the lesions, and reactivity for CK7 was evident on intermediate and deeper structures. Focal cells were positive for CK18, and there was no reactivity for CK20. Spindle cells on the lamina propria were reactive for smooth muscle actin. The diagnosis was heterotopic gastrointestinal mucosa (HGM). No recurrence was observed 2 years after treatment. Neonates frequently present tumor-like oral lesions, some of which are choristomas, such as HGM. It has been thought that HGM develops because of entrapment of endodermal gastric mucosa in the midline of the tongue by fusion of the lateral lingual swellings over the tuberculum impar. HGM can be solid or cystic, and also is known as foregut duplication cyst. Most cases are observed as congenital masses in men or develop soon after birth. The floor of the mouth and the anterior tongue are the most frequently affected oral sites. Complete surgical excision is the treatment of choice, and recurrences are not expected. n

Stevens-Johnson syndrome: An oral viewpoint

The Stevens-Johnson syndrome (SJS) is a severe variant of erythema multiforme (EM) that occasionally can rise to systemic upset and possibly compromise life. In this report, we described important oral and dermatologic aspects of a case of SJS triggered by Mycoplasma pneumoniae infection.

Oral paracoccidioidomycosis as a differential diagnosis of oral cancer

Paracoccidioidomycosis (PCM) is a deep mycosis characterized by mucocutaneous lesions, lymphadenopathy, and pulmonary involvement caused by Paracoccidioides brasiliensis , which mainly affects the skin, lymph nodes, lungs, and oral, nasal, and gastrointestinal mucous membranes. The main clinical differential diagnosis of oral and laryngeal mucous membrane lesions is cancer (i.e., squamous cell carcinoma). Depending on the specific immunity of the host, the infection can assume many forms and to affect multiple organs, and can eventually become a severe or fatal disease. In this paper, we highlight the important aspects for the differentiation of infectious diseases such as PCM and malignant neoplasm.

Primary amelanotic mucosal melanoma of the oronasal region: report of two new cases and literature review

Primary amelanotic mucosal melanoma is a rare entity with challenging histopathological features. Because these tumors are thought to be biologically more aggressive, they have a poorer prognosis than that of pigmented melanomas. In this work, we present a literature review about the clinical, histopathological, and immunohistochemical features of primary amelanotic mucosal melanoma of the oronasal region and report two new cases. Amelanotic mucosal melanoma commonly affects men in the seventh decade of life and tend to have a poor prognosis, as seen by the high incidence of metastasis, recurrences, and, ultimately, death. There is a similar pattern in the clinic-pathological predilections (such as age, gender, primary site, and metastatic potential) of amelanotic mucosal melanoma when comparing with data reported for pigmented lesions. This work reinforces knowledge about amelanotic mucosal melanomas and epidemiologic predilections. The optimal management of this lesion remains controversial.

Differential metallothionein expression in oral lichen planus and amalgam-associated oral lichenoid lesions

Background Oral lichen planus (OLP) is a chronic inflammatory disease mediated by T cells, which manifests as reticular (white) or erosive (red) lesions, that are eventually painful. Oral lichenoid lesion (OLL) are distinguished from OLP by the presence of precipitating factors. The aim of this study was to evaluate whether the presence of metallothionein, which is involved in anti-apoptotic pathways and the anti-oxidative response, could serve as a differential diagnostic for OLP and OLL. Material and Methods We evaluated the expression of metallothionein in 40 cases of OLP and 20 cases of OLL using immunohistochemistry. Results and Conclusions White OLP has higher concentrations of metallothionein than red OLP in basal and parabasal layers. Moreover, metallothionein was more frequently observed in the cytoplasm and nuclei of basal cells in OLP patients compared to the same regions of OLL cases. Metallothionein levels are related to OLP severity and may contribute to a differential diagnosis between OLP and OLL. Key words:Oral lichen planus, oral lichenoid lesions, autoimmune disorders, metallothionein, immunohistochemistry.