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Background Oral leukoplakia is the most common potentially malignant lesion, the etiology of this change is still uncertain which makes it difficult to predict when this will undergo malignant transformation. Recent studies have examined the involvement of mast cells in this process, it is believed that these cells through the release of pro-angiogenic factors influence the processing mechanism of such lesions through promoting angiogenesis. It was the objective of this study to evaluate the inflammatory process in oral leukoplakia comparing it to a non-cancerous lesion correlating the intensity of mast cells with inflammatory infiltrate and vascularization in these lesions. Methods A total of 20 selected cases divided into two groups, oral leukoplakia and inflammatory fibrous hyperplasia (IFH). Histochemical Technique of Toluidine Blue was applied to enhance mast cells and histomorphometry for quantifying mast cells, blood vessels and inflammatory cell infiltration by capturing digital images of the samples and analysis software Image Java version 1.48v. Mast cells and blood vessels were counted in 10 different areas and the intensity of the inflammatory infiltrate was measured in three areas. The analysis of variance (ANOVA) was used for between-group variation, a P value of 0.05 for statistical significance. Results It was observed a reduction in the concentration of mast cells in oral leukoplakia compared fibrous inflammatory hyperplasia. In contrast to the concentration of blood vessels were present in higher concentrations in the Oral leukoplakia lesions. The inflammatory infiltrate in most cases was considered scarce, except in a case where that IFH was intense and a case of moderate inflammatory infiltrate in oral leukoplakia. Conclusions The results showed reduction in the number of mast cells in the oral leukoplakia and greater intensity in the inflammatory process in the IFH, suggesting a possible carcinogenic influence in the microenvironment oral leukoplakia.

We report an unusual case of a 1.5-cm dark macule on the edentulous posterior mandibular alveolar ridge. The lesion affected a 62-year-old woman referred by a clinician to the oral medicine service with suspect of melanoma. Clinical investigation found no signs of pain and discomfort. The patient stated she had not noticed the lesion previously. An excisional biopsy was performed and during the excision a loose brownish granular material within the submucosa and over the mandibular bone surface was seen. This material was curetted and submitted for microscopic evaluation. The histopathologic report described a loosely organized connective tissue with blackened granular agglomerates that also stained the elastic collagen fibers dispersed in the matrix and in the vessel wall leading to a foreign body–type granuloma with focal argyrosis (amalgam tattoo). Postsurgical follow-up of 11 months was uneventful.

Kuttner tumor chronic sclerosing sialadenitis is graded in 4 stages, but most of the lesions are usually diagnosed in the 2 intermediary stages. We present a case affecting a female patient, 57 years old and white, who sought the oral medicine service because of a small tendered nodule on the buccal mucosa. Intraoral examination revealed a sessile, painless, and normal-colored fluctuating nodule, resembling a mucocele. After excisional biopsy, the material was submitted to a microscopic evaluation that revealed dilated salivary ducts with ectasia and peripheral fibrosis with intense hyalinization in addition to a discrete periductal lymphocytic infiltrate in the middle of a stroma of adipose tissue of usual appearance. That suggested diagnosis of advanced stage chronic sclerosing sialadenitis (Kuttner tumor). Further clinical and laboratory examinations ruled out the other immunomediated diseases. Postoperative follow-up showed no signs of recurrence, and the patient was released.

The present study reports a rare case of anaplastic malignant melanoma in a 23-year-old female patient, in the anterior maxilla. On clinical examination, the lesion presented as a 5-cm sessile nodule, with brownish irregular macules on the mucosal surface, painless, with a firm consistency ranging from teeth 14 to 24 with palatal and nasal extension causing facial asymmetry and dental mobility. The computed tomography showed irregular lytic bone reabsorption, without dental involvement. The incisional biopsy followed by microscopic examination suggested primitive neuroectodermal tumor, due to the presence of round blue cells, periodic acid-Schiff (PAS)-positive clear cells, with considerable pleomorphism, atypical mitosis, hemorrhagic areas, and coagulative necrosis. Immunohistochemistry revealed high-grade epithelioid neoplasm and a diagnosis of invasive melanoma was concluded; the melanoma was positive for S-100 protein, gp100, and SOX 10 antigens. The patient underwent partial maxillectomy with no postsurgical complications after 3-month follow-up. The aggressive nature of the lesion and its prognosis are discussed.

A 54-year-old black female patient sought dental care due to a sessile, fluctuating nodule on the left hemiface, normal colored, with an 8-mm width. During clinical examination, a large lump on the dorsum was noticed, which was suggested to be a lipoma by the patient. Fine needle aspiration cytology was carried out followed by an excisional biopsy. Microscopic evaluation diagnosed a nodular neurofibroma, and advised further investigation to rule out the chance of being a case of neurofibromatosis. Additional clinical examination found cafe-au-lait spots, Lisch nodules, multiple subcutaneous nodules on other parts of the body, and enlarged fungiform papillae of the tongue. Neurofibromatosis type I is the most common manifestation of the syndrome, but as shown in the present study, its diagnosis can be difficult because of the discrete presentation of its stigmata, caused by skin and eye color, as well as absence of superficial neurofibromas.

Intraneural perineurioma is a rare lesion of the peripheral nervous system with unique ultrastructural features, and it is distinct from Schwann cell-derived entities (schwannoma and neurofibroma). The present case aims to report a lesion in the lower lip in a 33-year-old female patient. Clinical examination showed a nodular growth, sessile, and smooth surfaced from an undetermined etiology. Histopathologic examination revealed slender spindle cells, arranged in 2 fascicles, and focal areas showing a distinct storiform pattern, surrounding by histiocytes. Histopathologic investigation comprised of toluidine blue, Masson trichrome, and picrosirius red showed presence of mast cells, collagen organization, and type III prevalence. Based on clinical and histopathologic findings, the final diagnosis was intraneural perineurioma. Eight-month follow-up showed no recurrence. We will discuss histopathologic and histochemical aspects of interest for intraneural perineurioma diagnosis.

We present a case of an early stage florid cemento-osseous dysplasia with a large simple bone cyst. The patient, a 40-year-old woman with light brown skin color, presented to the oral medicine service complaining of pain and swelling in the right body of the mandible. Imaging examination revealed a large multiloculated lesion with a well-delimited bilobular radiopacity measuring together 3 × 1.4 cm. The cystic cavity was accessed surgically and was empty. A saucerization of the bone was performed thereby stimulating blood to fill the cavity. Also, an incisional biopsy was performed in part of the dysplastic bone. Histopathologic examination confirmed it to be a cemento-osseous dysplasia. Patient was monitored for 12 months, with satisfactory improvement of the bone in the surgically accessed site.

Nasopalatine duct cyst in edentulous areas may be associated with local pain, presence of mucosal patency of the duct, and even secondary infection. The present study aims to report the case of a 52-year-old black female patient who attended the dental institution complaining of pain in the anterior palate area. The patient reported a history of previous procedure to puncture and remove fluid from the anterior maxilla, in the past 6 years, as an urgency procedure but evaded treatment due to partial remission of the symptoms at that time. In the intraoral clinical examination, there was no presence of color alteration as well as swelling in the anterior palate area. The tomographic examination suggested a nasopalatine duct cyst. An excisional biopsy was performed and the material was referred for histopathologic analysis, confirming the diagnosis. After 6 months of follow-up, the patient was released with no further complications.

The term pulse granuloma represents a rare inflammatory reaction to vegetable tissue, sometimes found in the aerodigestive tract. We report a case of a pulse granuloma found as an etiologic factor of a collateral cyst. The 22-year-old female patient sought oral surgery service to extract the lower third molars. Clinical examinations and panoramic radiography revealed the presence of a well-delimited, unilocular, radiolucent lesion adjacent to the unerupted crown of element 38. Treatment comprised surgical removal of the tooth and enucleation of the lesion. Histopathologic analysis showed cystic cavity partially covered by odontogenic epithelium presenting amorphous eosinophilic material, fragments of vegetal tissue covered by microbial biofilm, and microbial agglomerates rich in Actinomyces ssp. The vegetable inclusion in this case comes from the communication of the cystic cavity with the oral cavity. The patient did not present clinical or radiographic signs of recurrence after 6 months of follow-up.

The present study aims to report an interesting case of secondary actinomycosis infection of a nasopalatine duct cyst, with a radiopaque surfur granule and calculus formation. The patient, a 30-year-old female with light-brown color skin, was referred to the oral medicine service with spontaneous pain in the region of upper central incisors. During anamnesis, an endodontic treatment in tooth 21 was found. Periapical radiographic examination revealed a radiolucent, unilocular, well-defined, heart-shaped lesion in the midline. Scanning tomographic examination revealed a radiodense round substance surrounded by a radiolucent halo. A hypothesis of nasopalatine duct cyst with a foreign body was raised. Excisional biopsy of the lesion was performed revealing the presence of a brownish, granular, calcified material within the cystic lumen. Histopathologic examination elucidated the diagnosis with histochemical characterization of the actinomycosis infection. Postoperative follow-up of 12 months was uneventful. The microscopic characterization of sulfur lithiasis is discussed.

We report the challenges faced in the treatment of a large cystic lesion in the anterior maxilla. A 32-year-old woman presented herself to the urgency service, complaining about discomfort in the region of nonvital tooth #22. Endodontic treatment was started and the patient reported to the oral medicine discipline of the authors’ institution. Imaging and clinical examination revealed a large cystic lesion involving the hard palate, nasal cavity, and the anterior portion of the maxillary sinus. A cystic decompression was performed along with an incisional biopsy that led to a histopathologic diagnosis of periapical cyst. A second surgical approach tried to enucleate the lesion but the ostium of decompression remained open, thereby impairing bone formation. A third approach was performed along with allogeneic particulate bone graft and reabsorbable membrane barrier positioning. Radiographic follow-up showed the graft integration and good recovery of the lesion after 4 months of follow-up care.

Primitive tumors are considered rare, malignant, small and round-cell tumors that represent a disease of childhood and categorized into the Ewing family of tumors due its similarities. Herein we report a case of primitive tumor in a pediatric patient with lethal evolution. A 1-year-old black male patient was showing an expansive lesion in the left hemimandible, 8 cm in diameter, exhibiting superficial telangiectasia, crackling consistency, similar to a mucous membrane. The radiographic findings revealed irregular lytic radiolucency. An incisional biopsy was performed and the histopathologic report suggested a mucoepidermoid carcinoma. A histochemical and immunohistochemical panel was performed with the following markers: PAS-stain (+), DAK-p63 (+), AE1 ⁄AE3 (+), S-100 (+), and calponin (focaly +). The patient died 2 months after the biopsy procedure, before the immunohistochemical report was finished. We discuss the aggressive nature of such a rare tumor.

The present study reports the challenges faced during the diagnosis and treatment of chronic suppurative osteomyelitis in a patient with autism spectrum disorder (ASD). A 23-year-old woman intern in a special care institution attended the special care dental clinic of the authors with an unusual periodontal lesion involving tooth 47. Tooth extraction was performed with curettage of the surrounding structures for histopathologic examination. Microscopic examination diagnosed an aggressive juvenile periodontitis leading to suppurative osteomyelitis. Based on the pathologic report, a tomographic examination was performed and revealed the extension of the bone destruction as well as bone sequestrum. The patient was referred for surgical approach under general anesthesia to remove all necrotic and infected bone. After 1 year of the diagnosis the patient still under treatment without complete resolution of the lesion.

This case reports a conservative treatment of a large cystic lesion in the midline of the mandible. The 54-year-old female patient underwent clinical examinations and computed tomography because of a swelling with a hard consistency located in the vestibular region of the middle line of the mandible. A fine needle aspiration cytology and incisional biopsy procedure were performed. The histopathologic analysis showed a thin epithelial lining with no projections with prominent areas of the capsule, resulting in the diagnosis of residual cyst. The treatment was defined as the decompression of the cyst, followed by enucleation with the purpose of bone neoformation, and the closure of the vestibular wall with flap rotation. The patient was followed up without relapse, presenting total bone recovery. Decompression is a good option because it allows the bone defect to heal without grafting and guided regeneration in cases of inflammatory nature.

The aim of the study is to report a case of a large simple bone cyst mimicking a periapical lesion. A male patient was referred with radiographic suspicion of a periapical cyst. The radiographic and computed tomographic examination showed a well-defined 3.5-cm wide well-defined radiolucency in the periapical region of teeth 31, 41, 32, 42, and 43 with root displacement of tooth 43. The intraoral clinical examination revealed no significant alteration, and vital teeth related to the lesion site. The final diagnosis was established after an incisional biopsy. Fine needle aspiration cytology collected a bloody content and exploration of the cystic cavity revealed absence of soft tissue or fibrous capsule. The microscopic evaluation revealed areas of hemorrhage with eventual polymorphic nuclear leukocytes. The patient was treated with steroid infiltration, and the postoperative follow-up period through computed tomography showed total regression of the lesion after 6 months.

The present work aims to report a case of dentinogenic ghost cell tumor (DGCT) associated with compound odontoma (CO). An 8-year-old patient was referred to the oral medicine discipline presenting with dental retention. Computerized tomography (CT) scan revealed a well-defined unilocular radiolucent lesion involving an irregular mass, associated with an unerupted permanent upper central incisor (tooth 21). Excisional biopsy was performed. Histopathologic analysis revealed enamel matrix, loose connective tissue resembling dental pulp, enveloped in a fibrous capsule, associated with odontogenic epithelium sheets presenting aberrant keratinization, and containing abundant dentinoid and osteoid material. Based on clinical and histopathologic findings, the final diagnosis was DGCT and CO. Since spontaneous eruption failed to occur within the expected time frame (6 months’ follow-up), surgical exposition of the crown and bonding of an orthodontic appliance for traction was done to facilitate eruption. Up to now, the patient is under follow-up care in the orthodontics clinic.

We report a rare case of late diagnosis of malignant osteopetrosis due to clinical investigation of multiple intraoral fistulae and trismus in a 35-year-old male patient. The patient reported history of various complicated dental extractions during his life, facial scars that he could not attribute with certainty to old external fistulas, but besides his blindness, present since his childhood, he never had any other significant disease previously diagnosed. A computerized scanning tomography was performed and revealed a marblelike sclerotic pattern of all cranial bones, thickened parietal bone, and a narrowing of the encephalic space and optic canal. Further laboratorial and imaging studies revealed complete sclerosed bone of the chest and pelvis, anemia, reticulocitosis, extramedullary hematopoiesis, altered lactate dehydrogenase, and acid phosphatases. An interdisciplinary treatment was started with medical and dental care monitoring, and the patient is still under follow-up care after 1 year.

Facial cosmetic procedures are increasing in demand for plastic surgeons and dental professionals nowadays. This study highlights some of the risks related to such procedures, reporting a case of a painful, fluctuating nodule in the midline of the vestibular sulcus, extending to the upper lip. The patient, a 32-year-old man, showed a normochromic swelling of the affected region with 2 years’ history of evolution. The patient stated that he underwent a rhinoplasty procedure 5 years earlier. An excisional biopsy was performed and the lesion was diagnosed as a foreign body granuloma caused by methylmethacrylate. A wide morphologic investigation with polarized light and fluorescence microscopy was applied in order to confirm the filling material. Multiple splintered synthetic spherules were noted; these spherules were surrounded by foreign body giant cells circumscribed by a thin fibrous capsule and infiltrated by lymphocytes. The clinical follow-up was uneventful after 7 months.

We report a case of late diagnosis of squamous cell carcinoma in an 88-year-old woman with a history of chewing and smoking tobacco for 77 years. The patient attended the urgency clinic of the authors’ institution complaining of pain related to a lesion on the maxilla with a 1-year duration. Clinical examination revealed a sessile, ulcerated nodule, red-white in color, extending from the maxilla to the oropharynx, affecting the hard palate and right alveolar bone crest. The diagnosis of squamous cell carcinoma was made based on an incisional biopsy specimen, and the patient was referred to a cancer center. Palliative assistance was the only possible approach and the patient died after 4 months. Late diagnosis of squamous cell carcinoma is usually fatal. The authors discuss the challenges of the public health system and the effect of public access for early diagnosis in a continental country like Brazil.

The present study aims to report a case of a cystic lesion affecting the left paramental edentulous mandible region in a 62-year-old female patient. The patient reported a 1-year growth history, and noted pain in the area during the last few months. Clinical inspection showed a multilobulated, translucent swelling with a well-defined cystic radiolucency aspect on imaging examination. Presurgical puncture of the lesion revealed a transparent liquid content. A cystic decompression was then performed and the obtained specimen from the roof of the lesion was submitted for histopathologic examination. The results indicated that the lesion was compatible with botryoid cyst. After 5 months, an enucleation of the lesion was performed. Surprisingly a new pathologic report changed the diagnosis to multicystic ameloblastoma. We discuss the microscopic characteristics and the changes observed on the product of enucleation, as well as its clinical implications.

Conservative treatment with intralesional steroid injection in bone cysts is considered a simple, low-cost technique that preserves vital structures, avoiding great defects to the patient. A 49-year-old black woman sought dental care with pain and numbness in the lower left side of the face. Extraoral examination showed tumefaction in the area corresponding to the lower molars. Computed tomography was performed, revealing a circumscribed intraosseous radiolucency in the region of teeth 36. Puncture with cytologic smear had a suggestive diagnosis of simple bone cyst. Minimal surgical access with little amount of soft and hard tissue was submitted to histopathologic examination. During the procedure, intralesional steroid injection was performed as a therapeutic approach. Histopathologic analysis confirmed the diagnosis. Periodical follow-up during 6 months found bone formation into the cystic cavity site, proving the efficacy of the treatment.

The present case report refers to a 61-year-old black man who was a smoker and alcoholic. He sought dental care reporting severe pain in the floor of the mouth area, dysphagia for 3 months, and enlarged lymph nodes. The lesion has evolved over a period of 2 years. The intraoral clinical examination revealed ulcerated bleeding lesion on the floor of the mouth with elevated borders with white spots, besides presenting a hairy tongue. An incisional biopsy was performed, and the histopathologic examination revealed it to be a well-differentiated microinvasive squamous cell carcinoma. The patient was referred to the oncology reference hospital, and we discuss the evolution of the case for the following 9 months until his death.