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The aim of the present study is to report the clinicopathologic features of 2 new cases of ameloblastic fibrosarcoma (AFS). Case 1 was a 9-year-old boy presenting with a painful ulcerated swelling in the posterior mandible causing facial asymmetry. Case 2 presented as an asymptomatic swelling in the anterior mandible of a 14-year-old female patient. Imaging exams revealed destructive multilocular radiolucencies with irregular margins, associated with impacted teeth, causing exuberant cortical expansion and tooth displacement. Microscopically, both cases showed mesenchymal cells with marked hypercellularity and nuclear pleomorphism containing small islands of odontogenic epithelium with peripheral palisading. Both patients were treated by surgical excision; case 1 showed recurrence after 2 years of follow-up. AFS usually affects the posterior mandible of young adults with previous history of ameloblastic fibroma; nevertheless, clinicians should also consider this rare odontogenic sarcoma when evaluating aggressive ill-defined radiolucent lesions in the mandible of pediatric patients. [ABSTRACT FROM AUTHOR]

This is a description of an extremely rare metachronous presentation of calcifying epithelial odontogenic tumor (CEOT) in a 52-year-old woman with a history of synchronous tumors 12 years earlier. The patient presented 2 peripheral CEOTs that appeared clinically as bilateral gingival swellings between the lower first premolar and canine. Both tumors recurred and an additional surgical removal was performed, with no recurrences observed after 3.5 years of follow-up. Eight years after the last consultation, the patient complained of an asymptomatic normochromic nodule of 2.5 cm in the lower posterior gingiva, causing saucerization of the alveolar cortical bone between the second premolar and first molar; the location ruled out the possibility of late recurrence. The diagnosis of CEOT was confirmed microscopically, with no additional tumor after 2 years. Long-term follow-up is recommended for patients with multiple CEOTs for better comprehension of this unique clinical presentation. [ABSTRACT FROM AUTHOR]

We report a case of exuberant brown tumors affecting the gnathic bones as the first manifestation of primary hyperparathyroidism (PHPT). A 34-year-old female patient presented with midfacial asymmetry caused by an 8- × 4-cm painful and bleeding swelling in the left posterior maxilla, showing progressive growth for the last 2 months. A 4- x 2-cm normal-colored swelling was also detected in the right body of the mandible. Medical history included hypertension, fever, and weight loss. Panoramic radiography showed multilocular radiolucencies, overall thinning of the inferior border of the mandible, and loss of the lamina dura. Incisional biopsy revealed central giant cell lesions, which were diagnosed as brown tumors of PHPT. High values of parathormone and alkaline phosphate were detected and microscopic diagnosis of parathyroid adenoma was established after parathyroidectomy. The patient received calcium and calcitriol supplementation. Both lesions decreased partially after 2 years of follow-up, with aesthetic surgery being planned. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the clinicopathologic features of 30 new cases of oral eosinophilic ulcers. Clinical data concerning sex, age, affected site, and clinical presentation of 30 patients from Latin America were collected from the files of 2 Oral Pathology Laboratories in a period between 1982 and 2018. The mean age of the patients was 53.3 years, with slight predilection for female patients (1.2:1). Medical history of one-third of patients included psychiatric disorders, alcohol drinking, diabetes mellitus, and human immunodeficiency virus (HIV) infection. The tongue was the most common affected site (76.7%) by lesions with mean size of 1.8 cm and mean evolution of 5.4 months. Raised edges, pain and clinical suspicion of squamous cell carcinoma (SCC) were reported in almost half of cases. Microscopically, all cases revealed a connective tissue covered by fibrinopurulent membrane, containing many capillaries with prominent endothelial cells and reactive inflammatory infiltrate. Variable number of eosinophils was observed, mainly located in the lamina propria, but also deeply between muscle fibers. Eosinophilic ulcer is likely a reactive painful lesion that mainly affects the tongue of adults, which may clinically mimic oral SCC. [ABSTRACT FROM AUTHOR]

Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse effect of antiresorptive (bisphosphonates and denosumab) and antiangiogenic therapy of oncologic and osteoporotic patients. We report a case of an 85-years-old female patient who developed MRONJ 4 months after a single subcutaneous injection of denosumab therapy (Prolia 60 mg) for osteoporosis. The patient presented painful fistula with purulent secretion in the posterior region of the mandible, with no bone exposure, showing a small bony sequestrum only revealed by computerized tomography. The patient was conservatively managed with amoxicillin 500 mg/potassium clavulanate 125 mg and paracetamol 500 mg/codeine phosphate 7.5 mg. Complete healing was observed after 21 days of treatment, and no surgical intervention was required. The patient did not present new events after 1 year of follow-up, with no use of removable denture. [ABSTRACT FROM AUTHOR]

Acantholytic squamous cell carcinoma (AcSCC) is a rare variant of poorly differentiated oral SCC of aggressive behavior that contains marked acantholysis, resulting in an adenoid appearance. A 58-year-old man presented an extensive painful and necrotic mass affecting the lower lip mucosa and skin, which appeared ulcerated and hardened for the last 5 months. The patient's cervical lymph nodes were palpable, and previous heavy tobacco use was reported. Intraoral examination showed an 8 × 6 cm ulcerated mass affecting lower anterior alveolar ridge with extension to the floor of the mouth and anterior mandible, which was completely destroyed in the image of panoramic radiograph. An incisional biopsy was performed, and microscopically, infiltrative malignant nests containing many acantholytic and dyskeratotic squamous cells were observed. The final diagnosis was of AcSCC, and the patient was referred for treatment. Oral AcSCC may appear as an exuberant infiltrative mass causing extensive bone destruction. [ABSTRACT FROM AUTHOR]