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Adenoid cystic carcinoma (ACC) is a malignant epithelial tumor of the salivary glands that commonly affects the minor salivary glands, and the palate is the most recurrent site. Treatment is challenging because this tumor tends to recur with distant metastases and poor prognosis. A 50-year-old woman complained of numbness in the upper left hemimaxilla, extended to the labial region, nose wing, and nasolabial sulcus, with clinical intra-oral alterations similar to an endodontic fistula tooth 25 palatal mucosa and discrete periapical rarefaction on radiologic evaluation. Endodontic treatment was provided with laser therapy administered for persistent numbness. After 3 months a palate volume increase and small ulcerated region were noted encompassing the region of teeth 24 to 27. The panoramic and tomographic examination was performed showing extensive bone destruction, and the patient underwent a biopsy followed by microscopic and immunohistochemistry evaluation and diagnosis as ACC. The patient was forwarded to a head and neck surgeon.

A primary cutaneous CD-30 positive T -cell lymphoproliferative disorders are rare and heterogeneous group of primary skin tumors, which include primary cutaneous anaplastic large cell lymphoma (PCALCL) and lymphomatoid papulois. We report a rare an atypical case of PCALCL with an aggressive and refractory behavior that occurred in the lip vermilion, and that had been initially diagnosed as aggressive herpes. The lesion was recurrent and refractory to the CHOEP chemotherapy protocol followed by radiotherapy, but after hyper CVAD (acronym) + brentuximab with a considerable improvement. After 4 cycles of hyper CVAD plus brentuximab, the patient underwent 100% compatible sibling bone marrow transplantation, with success in the procedure. Primary cutaneous anaplastic large cell lymphoma is a rare disease of difficult diagnosis and may be confused with chronic infectious diseases, postponing treatment.

Renal osteodystrophy is a term that encompasses complications of bone metabolism associated with chronic kidney disease. Progressive loss of renal function raises parathyroid hormone levels (PTH) favor high bone turnover and skeletal manifestations. The clinic condition is a diagnostic and management challenge. A 37-year-old man, chronic renal, was referred by endocrinologist for evaluation of expansive gingiva lesion, present for 3 months, with a histopathological diagnosis suggestive of osteosarcoma. On the extraoral examination, facial asymmetry of rapid evolution and intraoral presented bone swelling of the jaws, hard palate, and dental mobility. Radiography and computed tomography findings reveal alterations in cortical and medullary spaces. Laboratory tests showed high parathormone, phosphorus, and alkaline phosphatase. The histopathological exam was reviewed considered the clinical and biochemical history, excluded malignancy and was compatible with renal osteodystrophy. The patient was referred to the head and neck surgeon and submitted parathyroidectomy and followed up by dentist and medical team.

The aim of this study was to assess gender differences in prognostic factors among patients treated surgically for oral squamous cell carcinoma (OSCC). The medical records of 477 eligible patients (345 males, 132 females) obtained from the Brazilian Cancer Institute were reviewed. Survival was calculated by Kaplan–Meier method. Cox regression models were used to obtain adjusted hazard ratios (aHR) for males and females. Multivariate analysis showed that past tobacco use (aHR 0.2, 95% confidence interval (CI) 0.1–0.7) and regional metastasis (aHR 2.3, 95% CI 1.5–3.5) in males, and regional metastasis (aHR 2.2, 95% CI 1.2–4.3), distant metastasis (aHR 6.7, 95% CI 1.3–32.7), and hard palate tumours (aHR 11.8, 95% CI 3.3–47.7) in females, were associated with a higher risk of death. There were no differences in survival between males and females. Regional metastasis was found to be a negative prognostic factor in OSCC for both genders. Past tobacco use was an independent prognostic factor for worse survival among males, while distant metastasis and hard palate tumours were independent prognostic factors for worse survival among females. Further studies are necessary to corroborate the relationships found in this study.

Eosinophilic ulcer (EU) is a chronic, benign, and self-limiting condition, more common in the tongue of men. This study reports 4 patients diagnosed as having EU. Of the cases studied, 3 involved men and 1 involved a woman, with a mean age of 60 years. All lesions were described as ulcers covered by a membrane of fibrin with raised margins, which were rigid to touch, and a red halo located at lateral tongue. The mean lesion size was 1.45 cm, and the lesions were present for 10 to 60 days. Squamous cell carcinoma was among probable diagnostic hypothesis in all cases. An incisional biopsy was performed, and the histopathologic analysis revealed an EU in all cases with intense inflammatory infiltrate and presence of eosinophils. After the biopsy and removal of the causative agent (if detected), all the lesions regressed. Performing a biopsy is extremely important to differentiate EU from squamous cell carcinoma.

Gardner syndrome (GS) is an autosomal dominant disease characterized by adenomatous intestinal polyps, and if not treated, shows a great chance of becoming malignant. Multiple osteomas in the skull, maxilla, and mandible, along with multiple cutaneous and subcutaneous masses are also characteristics of GS. A 30-year-old woman reported an epidermoid cyst on the frontal bone and a scar on the left shoulder due to osteoma removal. Tooth absence, malocclusion, and osteoma in the palatal region were observed in the intraoral exam. A panoramic radiography analysis revealed permanent teeth retention, supernumerary teeth, and radiopaque areas suggestive of osteomas. Although there were Gardner syndrome manifestations, only after our evaluation, a colonoscopy examination was ordered and intestinal polyps were removed with a diagnosis of tubular adenoma with low grade dysplasia. Today, the patient is under follow-up with a gastroenterologist and oral and maxillofacial surgeons, orthodontists, and stomatology experts with a common goal of function, esthetic, and quality of life improvements.

Osteolipoma is an extremely rare histologic variant of lipoma that contains mature lamellar bone. We report a case of a 27-year-old man with history of a small, rounded lesion in the right cheek that started in childhood, without symptomatology, but with continuous growing. On the examination, facial asymmetry was observed, without lymph node enlargement. A firm nodule of about 2.5 cm was seen involving his right buccal mucosa. A panoramic radiograph showed radiopaque irregular shapes in the region of the first upper and lower right molars. The lesion was excised, and pathologic examination of the specimen showed fragments of trabecular bone between adipocytes. Definitive pathologic diagnosis was osteolipoma. There was no recurrence at 7 months’ follow-up. Although osteolipoma is very rare, it is important to keep it in the differential diagnosis of nodules with a firm consistency in the oral mucosa and when noting a radiopaque image on panoramic exam.

An 81-year-old white female, with no history of smoking or drinking, reported persistent pain and increase in lesion size in the last 3 months. Intraoral exam showed an exophytic nodular and ulcerated lesion in the region of left labial commissure, 1.5 cm in size and of soft consistency; next to the lesion, there was an extensive white plaque. A white plaque with striated appearance was also observed on the right buccal mucosa. An incisional biopsy was performed in the nodular area with the histopathologic diagnosis of squamous cell carcinoma. The patient was referred to the head and neck service for treatment. This carcinoma case may have been preceded by oral lichenoid lesions and proliferative verrucous leukoplakia and these lesions should be detected during clinical exam and followed closely, as they carry a higher risk for malignant transformation and carcinoma arising from them and may show better prognosis if detected early.

White sponge nevus (WSN) is a rare autosomal dominant disorder with variable expressivity and high penetrance. Oral mucosa is the most affected region. Usually, this entity occurs at birth or later in childhood or adolescence. A 42-year-old man complained of white, asymptomatic lesions, which were present for more than 3 years. No family history of similar lesions was reported. Intraoral examination revealed nonremovable, symmetric, diffuse white plaques, all over the buccal mucosa, bilaterally, with a corrugated surface. An incisional biopsy was performed and histopathologic analysis revealed stratified squamous epithelium, with hyperparakeratosis, an extensive area with acanthosis and keratotinocytes with perinuclear eosinophilic condensation. Based on clinical and microscopic aspects, the diagnosis made was WSN. Further material was collected for cytopathologic examination in order to confirm the diagnosis. Treatment is not necessary due to the benign nature of WSN. Correct diagnosis is important to exclude other more serious lesions with similar characteristics.

Calcifying epithelial odontogenic tumor (CEOT) is an extremely rare, benign neoplasm, accounting for approximately 1% of all odontogenic tumors. Peripheral CEOTs commonly resemble oral hyperplastic or reactive lesions and are histologically similar to their intraosseous counterparts. We report an unusual case of multifocal peripheral CEOT. A 40-year-old female presented with bilateral soft, painful, erythematous, gingival swellings localized in premolar areas of the mandibular gingiva. The presumptive diagnosis was bilateral pyogenic granuloma. The masses were surgically excised under local anesthesia without bone curettage and both recurred 12 months later. Morphologic features, and histochemical and immunohistochemical tests revealed bilateral peripheral calcifying odontogenic epithelial tumor. There is no clinical or radiographic evidence of recurrence 3.5 years after excision. This multifocal phenomenon has been reported previously only for intraosseous CEOT. Gingival masses must be carefully evaluated for clinical and histologic evidence of neoplasia.