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Oral lymphoepithelial cyst (OLC) is a rare developmental cyst of soft tissue. Clinically, OLC exhibits as a small and asymptomatic mass, with color ranging from rose to yellowish. OLC develops manly in floor of mouth and lateral and ventral surfaces of tongue. Based on this, we aimed to report a case of OLC in a young patient. A 17-year-old male patient presented a painless nodular aspect located in floor of mouth with a history of evolution of 2 months. Clinical hypothesis was ranula. Excisional biopsy was performed, and histopathologic analysis revealed a cystic cavity lined by keratinized stratified epithelium; cystic lumen showed desquamated epithelial cells. Cystic capsule was composed of connective tissue exhibiting numerous lymphocytes, sometimes arranged in germinal centers. Superficially, epithelium of oral mucosa was observed. Based on pathologic findings, final diagnosis was OLC. After 12 months of follow-up, no sign of recurrence was observed.

Squamous odontogenic tumor-like proliferations (SOT-LPs) are an uncommon histopathological finding occurring in the fibrous capsule of odontogenic cysts, which share certain microscopic features with squamous odontogenic tumor (SOT). A 36-year-old woman presented with an 18-month history of a painless, slow-growing swelling in the maxilla. Her medical history was unremarkable. Computed tomography revealed a well-defined, unilocular hypodense lesion extending from nonvital tooth #21 to tooth #11, with expansion and rupture of vestibular cortical bone, measuring approximately 1.5 cm. Under the diagnostic hypothesis of radicular cyst, an excisional biopsy was performed. Histopathological analysis disclosed a cystic cavity lined by nonkeratinized stratified squamous epithelium exhibiting hyperplasia, exocytosis, and spongiosis. The fibrous capsule revealed conspicuous islands of well-differentiated squamous epithelium, some of them exhibiting foci of microcystic degeneration. The final diagnosis was radicular cyst with SOT-LPs. The patient remains under close follow-up.

Objective: To analyze the frequency and clinical and demographic features of oral lymphoepithelial cyst (OLEC) from 5 Brazilian services of oral and maxillofacial pathology. Study Design: Ethical approval (80249117.0.0000.5149). A cross-sectional retrospective study was conducted in 5 oral pathology services. The biopsy records were reviewed from 1952-2018. Cases with a microscopic diagnosis of OLEC were retrieved. Hematoxylin-eosin slides were reviewed by a single pathologist to confirm the diagnosis. Lesions of major salivary glands were excluded. Frequency and clinical and demographic data were analyzed descriptively. Results: Seventy-seven OLECs were found, representing 0.05% of the lesions submitted to diagnosis in the centers (n = 146,150). OLEC was predominantly diagnosed in females (n = 54; 70.1%). The mean age was 46.51 years (range [SD], 13-84 [14.80]). Lesions arose mainly in the tongue, lateral border (n = 31; 40.3%). The lesions measured up to 1 cm in size (n = 47; 61.0%) and were asymptomatic (n = 50; 64.9%). Twenty-four cases (31.2%) were white in color. Conclusion: OLECs are very uncommon diagnoses in oral pathology services. Lesions usually affect women, are small and asymptomatic, and located in the lateral border of the tongue. Detailed microscopic and immunohistochemical features will be accessed in the next step of this study. Support: CAPES, FAPEMIG, CNPq.

Objective: To evaluate the immunoexpression of autophagy-related proteins (p62 and Atg7) in odontogenic keratocysts associated with Gorlin syndrome (SOKCs) and nonsyndromic odontogenic keratocysts (NSOKCs).Study design: The percentages of immunopositive cells (nuclear and cytoplasmic/membrane) for p62 and Atg7 in the epithelial component of 25 SOKCs and 25 NSOKCs were assessed. The results were analyzed statistically using the nonparametric Mann-Whitney U test and Spearman correlation test. Results: Expression of p62 and Atg7 was observed in all cases studied. Compared with NSOKCs, SOKCs exhibited higher nuclear expression of p62 (P

Objective: To analyze the determinant clinical and histologic aspects in the establishment of the diagnosis of the glandular odontogenic cyst (GOC).Study Design: A cross-sectional study was performed in 2 oral pathology services. All slides of GOCs were reviewed and clinical data were obtained from the patient records. The determination of the diagnosis followed predetermined microscopic parameters according to the World Health Organization. Statistical analysis was performed in order to identify the predictive parameters for the diagnosis of GOC. Results: From the 9 patient cases of GOCs, 55.5% were male, with a mean age of 50.6 years, and 66.6% were located in the mandible. All cases presented with intraepithelial microcysts or duct-like spaces, clear or vacuolated cells, variable thickness of the cyst lining, and papillary projections into the lumen. Multiple compartments, surface eosinophilic cuboidal cells, and epithelial spheres or plaque-like thickenings were observed in 8 (88%) cases. Apocrine snouting of hobnail cells were present in 6 (66%), mucous goblet cells in 3 (33.3%), and cilia in only 1 (11%). Conclusion: The association between the predictive clinical and histopathological aspects for the diagnosis of this rare lesion is fundamental, since GOC has the potential to mimic other potentially more aggressive lesions.

Objective: To evaluate DNA base excision repair (BER) in APE-1 and XRCC1; and nucleotide excision repair (NER) in XPF proteins in benign epithelial odontogenic lesions with different biological behaviors. Study design: Thirty solid ameloblastomas (AMEs), 30 isolated odontogenic keratocysts (NSOKCs), 29 syndromic odontogenic keratocysts (SKOCs), 30 dentigerous cysts (DCs; n = 30), and 20 dental follicles (DFs) were evaluated quantitatively for APE-1, XRCC1 and XPF through immunohistochemistry. Results: All the odontogenic lesions studied revealed a statistically significant expression of APE-1 (nuclear), XRCC1 (nuclear), and XPF (nuclear and cytoplasmic) compared with DFs (P

Pyogenic granuloma (PG) is a non-neoplastic vascular tissue growth, which occurs in response to several stimuli. A 15-year-old nonwhite male patient presented with a nonsymptomatic lesion in the lower lip, which was noted for the first time 4 months before. Clinical examination revealed a rigid, brownish, well-delimited, and pediculated nodule, features that led to the clinical diagnosis of cutaneous horn. In an attempt to promote a better wound healing, total removal of the lesional area using the high-power diode laser (808 nm; 1.5 W; continuous mode) was decided. Microscopic examination revealed intense endothelial cells proliferation and new blood vessel formation, besides extensive ulceration areas. Based on these morphologic features, the final diagnosis of PG was established. The patient had very good healing of the incised area on the postsurgical examination and underwent long-term follow-up.

Oral squamous cell carcinoma (OSCC) is a more common malignant neoplasm in the oral cavity, being rare as simultaneous primary tumors. Based on this, we aimed to report a rare case of simultaneous OSCC. A 76-year-old female patient presented in intraoral examination 2 lesions, one localized in palate and the other localized in alveolar ridge, with history of evolution of 4 months. Both lesions had a tumoral aspect and corrugated and whitish surface. For lesion in palate was observed area of ulcerations. Incisional biopsy was performed for both lesions, and histopathologic analysis revealed a proliferation of atypical squamous cells in nests and sheets exhibiting atypical mitosis, moderate hyperchromatic nuclei, and nuclear pleomorphism. Final diagnosis was simultaneous differentiated moderate OSCC. Treatment indicated was surgery and radiotherapy, and after 12 months of follow-up, no sign of recurrence was observed.

Calcifying odontogenic cyst (COC) is a rare, developmental odontogenic cyst that usually arises in the anterior region of the jaws. An 18-year-old, dark-skinned man was referred for evaluation of a painless, slow-growing swelling in the maxilla, extending from tooth #21 to tooth #25. Extraoral examination revealed slight elevation of the left nasal ala, producing discrete facial asymmetry. Computed tomography showed an expansive, unilocular hypodense lesion with small hyperdense foci, measuring approximately 3.0 cm in diameter. Under the diagnostic hypothesis of COC, an incisional biopsy was performed. Histopathological analysis disclosed a cystic cavity lined by ameloblastoma-like epithelium, with focal accumulation of ghost cells. Calcifications within the ghost cells could also be observed. The definitive diagnosis was COC. The patient was referred for surgical treatment and remains under close follow-up.

Lipomas are mesenchymal neoplasms consisting of mature adipocytes, which account for only 1% to 5% of all oral benign tumors. These lesions are occasionally altered by an admixture of other mesenchymal elements that comprise an intrinsic part of the tumor. A 76-year-old white woman was referred for evaluation of a painless, slow-growing swelling on the tongue that had been identified 3 years earlier. Her medical history was unremarkable. Intraoral examination revealed a yellowish, soft, sessile nodule on the right lateral border and ventral surface of the tongue, measuring approximately 2 cm. Under the diagnostic hypothesis of lipoma, an excisional biopsy was performed. Histopathologic analysis revealed a well-delimited proliferation of mature adipocytes arranged in lobules and separated by thin septa of fibrovascular connective tissue. The final diagnosis was lipoma. Eight months after surgical excision, clinical signs of recurrence were not detected. The patient remains under clinical follow-up.

Central odontogenic fibroma (COF) is a rare, benign mesenchymal odontogenic neoplasm that has a wide patient age range and a relatively similar distribution in the maxilla and mandible. A 60-year-old woman was referred for evaluation of a painless, slow-growing swelling in the mandible, extending from the left ramus to the distal root of tooth #36, covered by normal mucosa. Computed tomography showed an expansive, unilocular hypodense lesion with hyperdense foci, associated with unerupted tooth #38, measuring approximately 4.5 cm in diameter. Under the diagnostic hypothesis of calcifying epithelial odontogenic tumor, an incisional biopsy was performed. Histopathological analysis disclosed a moderately cellular, fibroblastic connective tissue intermixed with inactive-looking odontogenic epithelial islands and strands. The definitive diagnosis was COF. The treatment consisted of enucleation, curettage, and extraction of the associated tooth. No signs of recurrence were observed after 14 months of surgical excision. The patient remains under clinical and radiographic follow-up.

The aim of the present study was to describe a case report on the treatment of recurrent herpes using photodynamic therapy as a therapy of choice. A 21-year-old white man presented for evaluation of vesicles arranged in a skin region just below the transition zone between mucosa and skin of lower lip. The clinical diagnosis was of recurrent herpes and, for treatment, photodynamic therapy was applied, with application of 0.1% methylene blue as photosensitizer and a pre-irradiation time of 5 minutes. The low power device used was Therapy XT, with wavelength of 660 nm, power of 100 mW, in a spot area of 0.028 cm2, using the total energy of 4.0 J. It was possible to observe total repair after 10 days of treatment and the patient remained in follow-up for 8 months without recurrences.

Condyloma acuminatum is induced disease by human papillomavirus that commonly affects the genital region and is rarely observed on oral mucosa. Pathogenesis is associated with sexual contact or trauma, and when it develops in children it can indicate sexual abuse. Based on this, we aimed to report a case of condyloma acuminatum in a child. A 9-year-old male patient clinically presented verrucous nodule, asymptomatic, with history of evolution of 18 months, measuring 1 cm, and localized in left side of lower lip. No signs of other lesions in the skin were present. Clinical hypothesis was squamous papilloma or condyloma acuminatum. Excisional biopsy was performed, and histopathologic analysis revealed hyperplasia of parakeratinized squamous epithelium, with exophytic projections exhibiting acanthosis and exocytosis. Clear cytoplasm cells, suggestive of koilocytosis, were also observed. Subjacent fibrovascular connective tissue was also seen. Based on histopathologic findings, final diagnosis was condyloma acuminatum. After 12 months of follow-up, no sign of recurrence was observed.

Squamous cell carcinoma (SCC) with a rhabdoid phenotype (SCCRP) is an extremely rare entity in the maxillofacial region. To date, only 2 oral SCCRP cases have been reported. The presence of this phenotype is associated with a worse prognosis than conventional SCC. A 44-year-old man was referred presenting painful facial asymmetry evidenced by increase of volume in the left maxilla with several months of evolution. Computerized tomography examination showed extensive osteolytic lesion on the left maxilla and maxillary sinus. The histopathologic analysis showed typical morphologic features of SCCRP constituted by polygonal and discohesive cells with large hyaline cytoplasmic inclusions and eccentric nuclei with single prominent nucleoli. Immunohistochemistry revealed positivity for CK AE1/AE3, epithelial membrane antigen (EMA), vimentin, CD138, INI-1, focally for α–smooth muscle actin, and CD68. Ki-67 was > 40%. Although rare, SCCRP should be considered in the differential diagnosis when assessing malignant neoplasms affecting the maxilla. FAPESP (2016/11419-0 and 2017/02502-4).

Objective To evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower-lip squamous cell carcinomas (LLSCCs), and to correlate the findings with clinicopathologic parameters (tumor size and extent, regional lymph node metastasis, clinical stage, risk of malignant transformation for AC and histopathologic grade of malignancy for LLSCCs). Study Design The percentage of HLA-DR–positive cells in the epithelial component of 24 cases of AC and 48 LLSCCs (24 with regional nodal metastasis and 24 without metastasis) were assessed. The results were analyzed statistically using the nonparametric Mann-Whitney test. Results Only 5 (20.8%) cases of AC (2 low risk and 3 high risk) exhibited expression of HLA-DR, with a very low mean percentage of immunopositivity. Most LLSCCs (97.7%) presented with expression of HLA-DR, with a relatively high mean of immunopositivity. The percentage of HLA-DR–positive cells tended to be higher in tumors with regional metastasis, and tumors in advanced clinical stages (P > .05). There was a tendency for higher expression of HLA-DR in low-grade LLSCCs, and in highly or moderately keratinized tumors (P > .05). Conclusions The results suggest a potential role for HLA-DR in lip carcinogenesis, particularly in the progression of LLSCCs. The expression of this protein can be related to the degree of cell differentiation in these tumors.

Objective Actinic cheilitis (AC), a potentially malignant disorder, exhibits unpredictable progression to lip squamous cell carcinoma. Therefore, this study describes clinical and pathologic findings of cases of AC. Study Design Observational and cross-sectional study. Sample was composed of 60 cases of AC diagnosed in the period from 2011 to 2017 in an oral diagnosis referral center. Clinical data of patients (age, sex, and race) and lesions (anatomic site, size, symptomatology, and type of biopsy) were obtained from records. Morphologic analysis was graded according to the World Health Organization (WHO) (2017). Results Mean age of patients was 57.9 ± 12.9 years old; male were most affected (n = 45; 75%), with ratio of 3:1. White individuals were most affected (n = 30; 50.0%). Lower lip was the anatomic site more affected (n = 58; 96.7%). In relation to clinical aspect, AC showed predominance of white lesions (n = 30; 50.0%), aspect of plaque (n = 25; 41.7%), size ≤ 1 cm (n = 29; 48.3%) and asymptomatic (n = 37; 61.7%). Incisional biopsy was the most performed (n = 29; 48.3%). Histopathologically, most AC cases were classified as mild epithelial dysplasia (n = 26; 43.3%). Conclusions The results showed that clinical aspects of AC can reflect morphologic findings, so it is important to make a more accurate diagnosis.

A 53-year-old male patient presented with an approximately 8-year history of an asymptomatic "blood blister" on the lower lip. Extraoral examination revealed a soft, purplish, lobulated swelling on the left side of the lower lip skin. Intraoral examination showed a well-defined, purplish stain and papules on the left lower lip and alveolar mucosa, measuring approximately 1.5 × 1.0 cm. The diagnostic hypothesis was vascular lesion, which was later confirmed by a positive diascopy result. Under local anesthesia, the patient was submitted to 2 clinical sessions of photocoagulation with high-intensity diode laser (Thera Lase Surgery; 808∼830 nm ± 20 nm, 2.5 W, defocused 2 mm beam in continuous mode). The postoperative course was uneventful. After 6 months of follow-up, the patient reported only mild sensitivity in the region. Clinical examination revealed fibrosis compatible with the tissue repair process without aesthetic or functional impairment.

Objective Biological behavior of oral squamous cell carcinoma (OSCC) in young patients is controversial. Therefore, this study compared prognostic factors of OSCC between young and older patients, through a systemic review. Study Design Electronic search in the databases Pubmed/Scopus/Ovid/Proquest/Cochrane Library/Web of Science/Lilacs was performed until April 2018, without filters by language or year of publication. Only cohort studies were included and evaluated by Newcastle-Ottawa scale for risk of bias. Analysis of titles and abstracts was made by 2 calibrated researchers (kappa = 0.94). Results A total of 5370 articles were reviewed, and 10 of the most relevant articles that are suitable to the criteria were selected. All included studies had a low risk of bias. Independent of age group, male was more affected, and tongue was anatomic site more frequent. Main risk factors were smoking and alcoholism in both age groups. Most patients in both age groups were diagnosed in early clinical stages (I/II). Regarding to histologic grading, majority of OSCC was classified as moderately differentiated in both age groups. Lower survival was observed in older patients. Conclusions Among all prognostic factors evaluated, survival showed difference in age groups, suggesting, then, that OSCC in older patients could exhibit more aggressive biologic behavior.

Lower lip squamous cell carcinoma (LLSCC) represents frequent lip malignant neoplasms, and the majority is preceded by actinic cheilitis (AC), a potentially malignant disorder. In this context, we report 3 cases of AC and 1 of LLSCC, emphasizing the importance of thermography as an auxiliary tool in diagnosis. In AC and LLSCC, thermography showed, respectively, whitish areas with higher heat emission and reddish circular area of irregular thermal distribution. After acquisition of thermography images, incisional biopsies were performed to evaluate microscopic alterations according to the criteria described by the World Health Organization (2017). Of the AC cases, 1 was diagnosed as mild epithelial dysplasia and 2 were moderate epithelial dysplasia. LLSCC was confirmed on anatomopathologic examination. As a result, we observed that thermography is not able to distinguish the different degrees of epithelial dysplasia found in AC, but it is a new imaging method useful in distinguishing AC from LLSCC.

Ameloblastoma is a benign epithelial odontogenic neoplasm characterized by locally aggressive behavior. This lesion is often asymptomatic, and some cases are detected during routine radiographic examination. A 33-year-old female patient undergoing orthodontic treatment presented with a 1-month history of a painful swelling in the posterior mandible. Her medical history was noncontributory. Panoramic radiograph showed a well-defined, multilocular radiolucency on the left side of the mandible extending from tooth #37 to the mandibular ramus. A panoramic radiograph obtained for orthodontic documentation 7 years earlier revealed a well-defined, unilocular radiolucency associated with the crown of unerupted tooth #38. Under the diagnostic hypothesis of odontogenic keratocyst, an incisional biopsy was performed. Histopathologic findings confirmed the diagnosis of ameloblastoma. The patient was referred for surgical treatment and remains under close follow-up. This case emphasizes the importance of a detailed analysis of patient images, irrespective of the diagnostic goal, before any dental treatment planning.