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Background The term "symmetrical palatal fibromatosis" was recently suggested to designate bilateral palatal lesions presenting as typically broad, "mirror" images on the posterior lateral region of the hard palate. Purpose We report an additional case of this as-yet poorly understood oral lesion in a 67-year-old male patient, with emphasis on differential diagnoses and immunohistochemical characterization. Case Report The histopathological examination demonstrated a hypocellular, fibrous connective tissue with prominent thick collagen bundles and few blood vessels. Scattered large, stellate, and sometimes binucleated fibroblasts were found. Immunohistochemistry was positive for vimentin and negative for smooth muscle actin, S-100, desmin, HHF-35, AE1-AE3, Factor XIIIa, CD68, and FOSL1. This is the second study to show the immunohistochemical profile, with emphasis in FOSL1, of an additional case of symmetrical palatal fibromatosis. Conclusions We encourage further reports about this entity, especially in relation to immunohistochemical and molecular features, so far poorly described, but very important for better recognition of this entity. Key words:Palate, symmetrical palatal fibromatosis, desmoplastic fibroblastoma, immunohistochemistry.

Objectives Epithelioid rhabdomyosarcoma (EpiRMS) is a novel morphologically distinct variant of rhabdomyosarcoma, with an unusually challenging microscopic diagnosis. The occurrence of rhabdomyosarcomas in the jaws is extremely rare. This study presents the first case of EpiRMS in the jaw (mandible) and a literature review of the previous 35 cases of EpiRMS. Study Design Here, we report a case of EpiRMS affecting an 18-year-old male patient. Clinical, imaging, microscopic, and immunohistochemical features are discussed and previously reported cases of EpiRMS are reviewed. Results An 18-year-old male patient presented with an exophytic sessile growth on the buccal gingiva, and orthopantomography revealed irregular bone loss. Microscopic analysis showed a large number of cells with epithelioid appearance. Immunohistochemistry staining was positive for desmin, myogenin, MyoD1, smooth muscle actin, h-caldesmon, INI-1, and AE1-AE3. The patient's disease was staged as T4aN1M0 and was treated with surgical excision combined with chemotherapy. Conclusions The occurrence of RMS in the mandible is rare, and this is the first case of EpiRMS in the jaw. EpiRMS is an unusual histologic subtype that mimics other sarcomas and epithelial malignancies, making diagnosis a challenge. A specific immunohistochemistry panel aids in the diagnosis. EpiRMS has an aggressive course and an unfavorable prognosis.

Gingival lesions rarely occur in newborns. However, when present, they commonly worry the parents and impair the infant's feeding, thus affecting growth. Such lesions are usually nonneoplastic in nature, although malignancies may develop; therefore, specimens must be submitted for histopathologic examination. A 2-month-old girl presented with a 10-mm nodule on the anterior lower alveolar ridge in association with natal tooth extraction and neonatal tooth eruption. The lesion was excised with high-power laser under local anesthesia, and a histopathologic diagnosis of a peripheral ossifying fibroma was made. In addition to peripheral ossifying fibromas being rare in newborns, the use of high-power lasers for surgical procedures in newborns have been proven to be safe, comfortable, and efficient.

Introduction: A resurgence of syphilis in Brazil has been reported in recent years. Objective: With this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital. Methods: A retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected. Results: A total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%). Conclusion: The frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis. Resumo Introdução: Um ressurgimento da sífilis no Brasil tem sido relatado nos últimos anos. Objetivo: Investigar a frequência, as características demográficas e clínicas dos pacientes com sífilis adquirida com envolvimento oral que receberam atendimento médico em um centro de referência em medicina oral em um hospital público brasileiro. Método: Estudo retrospectivo, abrangeu 12 anos, feito para identificar tendências de mudança na sífilis. Registros médicos de todos os pacientes diagnosticados com sífilis adquirida que receberam atendimento médico na clínica de medicina oral do hospital de 2005 a 2016 foram revisados e os dados demográficos e clínicos foram coletados. Resultados: Foram diagnosticas 85 pacientes com sífilis adquirida, com um aumento significativo no número de casos nos últimos 5 anos. A idade dos pacientes variou de 16 a 76 anos, com pico na terceira e quarta décadas; 48 casos eram do sexo masculino (56,5%) e 37 do sexo feminino (43,5%). A maioria das lesões orais apareceu como úlceras ou placas únicas, os lábios e a língua representaram os locais mais afetados. Todos os casos foram positivos para Venereal Disease Research Laboratory e Fluorescent Treponemal Antibody Absorption Test e o tratamento foi feito com penicilina G benzatina na maioria dos casos (84,7%). Conclusão: A frequência da sífilis oral tem aumentado com o tempo e as lesões orais podem representar uma pista diagnóstica; portanto, os profissionais de saúde bucal devem ser conscientizados e devidamente treinados na tentativa de desenvolver um alto grau de suspeição clínica no diagnóstico da sífilis.

To evaluate the impact of the COVID-19 pandemic on the number of diagnoses of oral and maxillofacial lesions in public laboratories after one year of COVID-19 outbreak in Brazil.This is a cross-sectional study. Biopsies submitted to histopathologic examination from March 2019 to February 2020 (pre-pandemic period) and from April 2020 to March 2021 (pandemic period) in nine Brazilian public oral pathology laboratories were retrieved and the number of diagnoses, types of lesion, and percentage changes during both periods were analyzed.There were 7389 diagnoses in the pre-pandemic period and 2728 in the pandemic era, indicating a reduction of 63.08%. The reduction was 64.23% for benign lesions and 49.48% for malignant lesions, with a 50.64% reduction in squamous cell carcinoma. The largest decreases were observed in April 2020 and January 2021.An important reduction in the diagnoses of benign and malignant lesions was noted in the Brazilian public oral pathology laboratories during the first year of the COVID-19 pandemic.

Background The aim was to analyze the frequency, clinical and demographic features of solitary and multiple/diffuse oral pigmented lesions submitted to histopathological examination, and to summarize the features that guide the clinical differential diagnosis. Methods Clinical and demographic data were retrieved from biopsy records and descriptive statistics were performed. Results Nine hundred and five (0.51%) oral pigmented lesions were retrieved among 177 356 specimens, being 95.9% solitary and 4.1% multiple/diffuse lesions. Regardless the overlapping clinical presentation, age, site, association with amalgam restoration, and a nodular appearance may help in the clinical differential diagnosis of solitary oral pigmentations. Patient's habits, site, and systemic signs and symptoms are helpful in the clinical differential diagnosis of multiple/diffuse lesions. Conclusions Oral pigmented lesions are a rare diagnosis in oral pathology and solitary lesions are more commonly submitted to biopsy. Some key features help in the differential diagnosis, though biopsy can be warranted in doubtful cases.

Objective This study aimed to evaluate tumor budding (TB) and quantify the neutrophilic and lymphocytic infiltration in the invasive front of lip squamous cell carcinomas. In addition, the associations between these features and the histopathological grading in the invasive front were analyzed. Design A total of 43 lip squamous cell carcinoma surgical specimens were included and classified in accordance with a histological invasive front grading system. Immunohistochemistry was performed for CD66b and CD3 for the evaluation of neutrophils and T lymphocytes, respectively, in the invasive front of the tumors. Tumor budding was evidenced by AE1/AE3 staining. Results Thirty-six (83.7%) of the tumors were well-differentiated tumors. Eleven (25.6%) of the cases exhibited high-intensity tumor budding. There were low neutrophil and high T lymphocyte infiltrations in the invasive front, leading to a low neutrophil/T lymphocyte ratio in the same region. Moreover, we found an association between tumor budding and the pattern of invasion, and between the CD3+ cell count and the inflammatory infiltrate (p Conclusions The low neutrophil and high T lymphocyte infiltration in the invasive front, and the few high-intensity tumor budding cases are in accordance with the histopathological features of well-differentiated lip tumors. If these characteristics remain in lip squamous cell carcinomas with more aggressive histopathological features, it deserves to be investigated.

Tobacco smoking involves a high risk of human malignancies, including oral cancer, because it contains multiple carcinogens that cause genetic instability. Thus, a worse prognosis would be expected for cancer patients who are smokers. The aim of this study was to assess the DNA damage response through the expression of checkpoint kinase 2 (CHK2), H2A histone family member X (H2AX), and P53 among smokers and non-smokers with oral squamous cell carcinoma (OSCC). Associations between immunoexpression of proteins and clinicopathological data and histopathological grading were also analyzed. A total of 35 individuals (18 non-smokers and 17 smokers) with OSCC of the tongue and/or floor of the mouth were included. Immunohistochemistry for H2AX was conducted for the identification of double-strand breaks, CHK2, and P53 to evaluate the expression of this protein in cell cycle regulation. The sample consisted of 22 males and 13 females, with a mean age of 63.9±11.8 years. OSCC of non-smokers were well-differentiated tumors in 50% of the cases, and those of smokers were equally distributed into moderately differentiated and poorly differentiated tumors (35.3% each). Overall, 31 (88.6%) cases were CHK2-positive, 27 (77.1%) were H2AX-positive, and 23 (65.7%) were P53-positive, with no difference between smokers and non-smokers (p > 0.05). No association was found between proteins and clinicopathologic data (p > 0.05). Similarities in CHK2, H2AX, and P53 immunohistochemical staining patterns were observed between smokers and non-smokers, and immunoexpression was not associated with clinicopathological parameters. However, the findings indicated consistent expression of these proteins in OSCC.

BACKGROUND Benign connective and soft-tissue neoplasms (CSTNs) are unusual in the head and neck region. The aim of the present study was to evaluate the demographic and clinicopathological features of these neoplasms. METHODS A cross-sectional study was conducted of cases diagnosed as benign CSTNs, with data collected from biopsy records. The chi-square test was used. A p-value

Introdução: Medidas socioespaciais são amplamente utilizadas na pesquisa em saúde, mas ainda pouco exploradas em relação ao câncer de boca. Objetivo: Descrever as características sociodemográficas e clínicas do câncer de boca e analisar a distribuição espacial da doença em relação ao status socioeconômico do bairro, incluindo a disponibilidade de centros de saúde. Método: Foram coletados dados sociodemográficos, clínicos e histopatológicos dos pacientes atendidos no período de 2005 a 2015. Foram realizadas análises descritivas dos dados de todas as variáveis. A análise espacial foi realizada por meio do programa R. A distribuição geográfica dos endereços residenciais dos pacientes foi analisada usando a função K de Ripley e mapas de Kernel. A vulnerabilidade socioespacial foi definida pela renda familiar e adequação do domicílio. Resultados: Dos 127 pacientes incluídos, a maioria era do sexo masculino (76,4%), branca ou parda (82,7%), casada (35,4%), com baixa escolaridade (71,6%) e idade média de 59,5 anos. Os casos foram distribuídos em grupos caracterizados por menor renda mediana e condições sanitárias inadequadas. Conclusão: Os casos de câncer oral estão concentrados em regiões de baixa condição econômica. Embora os centros de atenção primária à saúde tenham sido homogeneamente distribuídos por toda a cidade, isso não é suficiente para promover o acesso dos pacientes e o câncer de boca continua sendo diagnosticado tardiamente. Introducción: Las medidas socioespaciales son ampliamente utilizadas en las investigaciones relacionadas con la salud, sin embargo, existen pocos estudios en relación con el cáncer oral. Objetivo: Describir las características sociodemográficas y clínicas del cáncer oral y analizar la distribución espacial de la enfermedad en relación con el estado socioeconómico del vecindario, la disponibilidad de centros de salud. Método: Se recogieron datos sociodemográficos, clínicos e histopatológicos de pacientes tratados entre 2005 y 2015. Se realizaron análisis descriptivos de los datos para todas las variables. El análisis espacial se realizó utilizando el programa R. La distribución geográfica de las direcciones de los hogares de los pacientes se analizó utilizando la función K de Ripley y los mapas de Kernel. La vulnerabilidad socioespacial se definió por el ingreso familiar y la adecuación del hogar. Resultados: De los 127 pacientes incluidos, la mayoría eran hombres (76.4%), blancos o morenos (82.7%), casados (35.4%), con baja educación (71.6%) y edad promedio 59,5 años. Los casos se distribuyeron en grupos caracterizados por ingresos medios más bajos y condiciones sanitarias inadecuadas. Los centros de atención primaria de salud se distribuyeron de manera homogénea en toda la ciudad. Conclusión: Estos casos de cáncer están concentrados en regiones con condiciones socioeconómicas relativamente mas bajas. A pesar de la distribución de la atención primaria, esta no suficiente para promover el acceso de los pacientes a ella y su diagnóstico continúa siendo tardío. Introduction: Socio-spatial measures are largely used in health research, but it is still unusual in oral cancer investigation. Objective: This study aims to describe the sociodemographic and clinical features of oral cancer and analyze the spatial distribution of the disease in relation to the neighborhood socioeconomic status including availability of health care centers. Method: Sociodemographic, clinical and histopathologic data were collected from patients treated from 2005 to 2015. Descriptive data analyses of all variables were performed. The spatial analysis was carried out through the program R. Geographic distribution of patients’ home addresses was analyzed using Ripley’s K function and Kernel maps. The socio-spatial vulnerability was defined by household income and home adequacy. Results: Of the 127 patients included, the majority were males (76.4%), Caucasian or Brown (82.7%), married (35.4%), with low educational level (71.6%) and mean age of 59.5 years. Cases were distributed in clusters characterized by lower median income and inadequate sanitary conditions. Primary health care centers were homogeneously distributed throughout the city. Conclusion: These oral cancer cases are concentrated in regions under relatively low socioeconomic conditions, and despite the homogeneous distribution of primary health care centers, it is not enough to promote access for patients and oral cancer remains being diagnosed late.

The present study reports a case of a mandibular buccal bifurcation cyst (MBBC) associated with a partially erupted mandibular first molar. The intraoral examination revealed vestibular swelling in the right mandibular permanent first molar region. Panoramic radiography and cone-beam computed tomography (CBCT) showed a well-delimited radiolucent image involving the roots and part of the crown of the right mandibular permanent first molar with bulging and areas of buccal cortical bone resorption. An incisional biopsy was performed and the diagnosis was MBBC. The lesion was surgically removed by enucleation and curettage. Bone repair was observed seven months after the surgical procedure.

Background This study compared three different concentrations of EO (1.25%, 2.5% and 5%) for the treatment of oral vascular anomalies (OVAs). Material and Methods This was a retrospective comparative analysis of patients with OVAs treated with EO. Anomalies smaller than 20 mm were included. The patients were treated with 1.25% (G1), 2.5% (G2), and 5% (G3) and clinical data were obtained. The number of sessions, the final volume and dose of EO were statistically analyzed to verify effectiveness and safety of the treatment. The different concentrations of EO were compared considering the number of sessions, the final volume and total dose of EO. Analysis of covariance (ANCOVA) was used to evaluate the influence of covariates on the outcomes. A p-value < 0.05 was considered significant. Results Nineteen women and 11 men with a median age of 54 years were included. The OVAs were most frequent in the lip (n=14) and cheek (n=9). All lesions exhibited complete clinical healing within 28 days. Patients of G3 required fewer sessions than those of G2 (p=0.017), a lower final volume compared to the other groups (p

OBJECTIVES To evaluate clinical, demographic, and histopathological characteristics of pigmented lesions of the oral mucosa. MATERIALS AND METHODS A cross-sectional study was conducted over a 64-year period. Information was collected from medical charts, and all archived histopathological specimens with diagnoses of any pigmented lesion were retrieved. Statistical analysis was performed using SPSS software. RESULTS A total of 34,127 archived specimens were reviewed, revealing 458 (1.34%) pigmented lesions, of which 230 were melanocytic and 228 nonmelanocytic. Most patients were females (74.2%), white-skinned (49.1%), in the third and seventh decades of life (mean of 45 years). Most lesions were macular (59.8%), followed by plaques and nodules (4.8%), measuring 0-5 mm (41.9%). Cheek mucosa (21.0%), alveolar mucosa (16.6%), and gingiva (11.8%) were the most commonly affected sites. Amalgam tattoo was applied in 212 cases (46.3%), followed by melanotic macule (22.9%) and nevus (20.5%). Other diagnoses included racial pigmentation, exogenous pigmentation, melanotic neuroectodermal tumor of infancy, melanoma, melanoacanthoma, smoker's melanosis, and heavy metal pigmentation. CONCLUSIONS Pigmented lesions represent an uncommon diagnosis in oral pathology routines. The most frequent entities are amalgam tattoo, melanotic macule, and nevus. Patients are usually middle-aged women presenting a small, long-lasting, macular lesion on the cheek mucosa.

Objective To compare the overall survival and the disease-free survival of patients with advanced oropharyngeal cancer subjected to different treatment protocols (surgery and radiotherapy [S+RT] vs chemotherapy and radiotherapy [CT+RT]). Study Design Medical records of patients treated for oropharyngeal squamous cell carcinoma with clinical tumor, node, metastasis (TNM) stage III or IV were retrospectively reviewed. Previously treated tumors were excluded. Clinic, demographic, and microscopic information were collected. Immunohistochemistry for p16 was performed. Kaplan-Meier survival curves were performed. Results Forty-seven cases were included, 41 men and 6 women, with a mean age of 56.3 years. Most patients were smokers (85.1%) and consumed alcohol (74.5%). Patients were staged III (21.3%) or IV (78.7%). Most lesions affected base of the tongue (31.9%). For the 23 cases available for p16 testing, 3 were positive (13.0%). Patients treated by S+RT (n = 18) had a better overall survival than those treated with CT+RT (n = 29) (P = .04). Disease-free survival did not differ between groups (P = .11). Similar survivals were observed for p16-positive vs p16-negative cases. Conclusions The prognosis of patients with advanced oropharynx carcinoma had an unfavorable prognosis, although individuals treated with surgery and radiotherapy presented a better overall survival than those treated by radiotherapy and chemotherapy. Support: FAPEMIG, PRPq-UFMG/PIBIC-CNPq.

A 53-year-old woman presented an asymptomatic lesion in the anterior maxilla, causing a discrete bone expansion and covered by healthy oral mucosa. Cone beam computed tomography showed coalescent and well-defined hypodense areas at the periapical region of teeth 11, 12, and 13, measuring 12 mm, with buccal cortical bone discontinuity. The diagnosis hypothesis of an odontogenic cyst was confirmed by microscopic examination after incisional biopsy. The lesion was enucleated and tooth 12 was removed. The surgical specimen analysis revealed multiple cystic spaces lined by a thin, nonkeratinized epithelium with plaquelike thickenings. Some clear cells were noticed. The cystic wall was of a fibrous connective tissue. The final diagnosis was of botryoid odontogenic cyst. After 9 months of follow-up, there are no clinical or radiographic signs of recurrence. SUPPORT: FAPEMIG.

Leiomyosarcoma (LMS) is an exceptionally rare tumor in oral cavity. The classical LMS can present with focal areas of pleomorphic cells; however, the coexistence of large pleomorphic component lets the tumor be designated as pleomorphic leiomyosarcoma (PLMS). This report describes the case of an 18-year-old man complaining of a painful mass in the retromolar area lasting for 15 days. On clinical exam, there was a granulomatous, ulcerated tumor mass extending to the retromolar area. This hyperplastic tissue was removed by incisional biopsy. The histopathologic exam revealed an extremely atypical tumor proliferation, with scarce areas of cells poorly arranged in fascicles and mixture of polygonal, rabhdoid, epithelioid, and spindle cells. Immunohistochemistry included desmin, smooth muscle actin (SMA), h-caldesmon, S-100, vimentin, Ki-67, AE1/AE3, HHF-35, and HMB45. The pleomorphic areas were strongly positive for h-caldesmon and SMA, and negative for the other markers. Treatment consisted of a partial mandibulectomy. The patient died a few months after the surgery. Support: FAPEMIG.

The aim of this study is to compare the immunoexpression of metalloproteinases 1 and 8 in giant-cell fibroma, inflammatory fibrous hyperplasia and normal mucosa. Twenty-two cases of giant-cell fibroma, inflammatory fibrous hyperplasia and oral mucosa (control) each were subjected to immunohistochemistry using anti-metalloproteinase-1 and anti-metalloproteinase-8 antibodies. Eight images of each case were captured and analysed through the a) application of a count grid to count the number of positive neutrophils, macrophages, lymphocytes, plasma cells, fibroblasts and blood vessels to obtain the percentage of staining and b) semi-automated segmentation quantifying the stained area in square micrometres. Statistical tests included ANOVA Two-way, Kruskal Wallis and Games-Howell, with a significance level of 5%. An increased percentage of metalloproteinase-1-immunopositive blood vessels were observed in giant-cell fibroma (26.6±22.4; p=0.02) and inflammatory fibrous hyperplasia (34.3±31.5; p=0.01) compared with the control group (19.6±9.2). No significant differences in inflammatory cells, fibroblasts and total area of metalloproteinase-1 and -8 were noted among the three groups. Metalloproteinase-1 apparently acts within the pathogenesis of giant-cell fibroma and inflammatory fibrous hyperplasia.

Objectives To assess the prognosis for early-stage oral squamous cell carcinoma according to tumor depth of invasion (DOI). Methods This study was logged in the PROSPERO database under protocol # CRD42017059976. The search was conducted in six electronic databases up to May 2019. Fixed-effects meta-analysis was performed for the calculation of the odds ratio (OR) and respective 95% CI. Primary outcomes were lymph node metastasis, recurrence, and survival. Heterogeneity was calculated by the I2 test. The certainty of evidence was assessed by Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results Twenty-seven studies were included (19 in the meta-analysis) with 2,404 patients with a mean of 60 years of age. High tumor DOI is associated with a greater chance of presenting lymph node metastasis, regardless of the cutoff point for DOI (13 meta-analysis; OR 1.69-53.08), recurrence (five meta-analysis; OR 1.22-3.83), and lower chance of survival (1 meta-analysis; OR 0.49). The certainty of evidence varied from very low to low. Conclusions Tumor DOI is a good prognosticator for early-stage OSCC. The findings of the current meta-analysis highlight the clinical relevance of DOI and corroborate its incorporation for staging OSCC.

This study aimed to evaluate tumor budding (TB) and quantify the neutrophilic and lymphocytic infiltration in the invasive front of lip squamous cell carcinomas. In addition, the associations between these features and the histopathological grading in the invasive front were analyzed.A total of 43 lip squamous cell carcinoma surgical specimens were included and classified in accordance with a histological invasive front grading system. Immunohistochemistry was performed for CD66b and CD3 for the evaluation of neutrophils and T lymphocytes, respectively, in the invasive front of the tumors. Tumor budding was evidenced by AE1/AE3 staining.Thirty-six (83.7%) of the tumors were well-differentiated tumors. Eleven (25.6%) of the cases exhibited high-intensity tumor budding. There were low neutrophil and high T lymphocyte infiltrations in the invasive front, leading to a low neutrophil/T lymphocyte ratio in the same region. Moreover, we found an association between tumor budding and the pattern of invasion, and between the CD3The low neutrophil and high T lymphocyte infiltration in the invasive front, and the few high-intensity tumor budding cases are in accordance with the histopathological features of well-differentiated lip tumors. If these characteristics remain in lip squamous cell carcinomas with more aggressive histopathological features, it deserves to be investigated.

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.

A 2-month-old girl presented with her parents with a nodular lesion on the anterior lower alveolar ridge, which has lasted for 45 days. The girl had a natal tooth (71), which was removed when she was 15 days old. Moreover, they reported current impairment in sucking, swallowing, and breathing. Physical examination revealed a nodular, firm, and pediculate lesion, measuring 10 × 5 mm, covered by a pink, flat, and smooth mucosa. Radiograph showed the absence of tooth 71 and tooth 81 erupting under the lesion. An excisional biopsy was performed under local anesthesia using a diode laser. Microscopic examination revealed a lesion covered by squamous epithelium, presenting a proliferation of round-shaped mesenchymal cells in the lamina propria, associated with deposits of mineralized material. The final diagnosis was peripheral ossifying fibroma, and the patient is free of recurrence after 9 months. Support: CAPES.

A 55-year-old man presented at the Oral Pathology Clinic complaining of a painless tumor lesion on the right lower alveolar ridge. The lesion was noted 9 years ago after extraction of molars. Intraoral examination showed an exophytic ulcerated white lesion, with a verrucous surface. Radiographic examination evidenced a superficial radiolucent, multilocular, and destructive area. Cone beam computed tomography revealed a hypodense image. The diagnostic hypothesis was squamous cell carcinoma. An incisional biopsy was performed, and the histopathologic diagnosis was ameloblastoma. The resection of the lesion was performed, and the patient is free of recurrence after 7 months. Ameloblastoma with an unusual development should represent a challenge to the clinical diagnosis.

Subgemmal neurogenous plaques are characterized as anatomic neural aggregates of ganglion cells and nerve plexus frequently associated with taste buds of the tongue. A 63-year-old male patient was referred to the oral medicine clinic presenting with severe pain and burning sensation in the tongue. Extra-oral examination revealed no alteration. Intra-oral examination showed an erythematous area, with pain sensation, measuring 2 × 2 mm, with 3 months of evolution, localized on the right posterior border of the tongue. The patient reported hypertension anddiabetes. An excisional biopsy was performed under local anesthesia. Microscopic examination revealed a mucosa covered by squamous epithelium with anatomic conformation of lingual papilla, associated with taste buds. Neural cell bundles and chronic inflammatory infiltrate were observed in the lamina propria. Immunohistochemistry was diffusely positive for S100. The diagnosis was subgemmal neurogenous plaque, and the patient was free of symptoms after 21 days. Support: CAPES

A 42-year-old female presented with asymptomatic fibrous submucosal mass that arose approximately 4 years earlier, in the left lower labial mucosa, measuring 40 mm. Aspiration showed a mucosanguinolent content. Histopathologic analysis of the incisional biopsy revealed glandular epithelial neoplasia characterized by proliferation of nests of cells in a fibrous connective tissue with areas of hyalinization. Signet ring cells, PAS-positive mucosal cells, and areas of mucus deposition were observed. Neoplastic cells presented severe cellular atypia. Immunohistochemistry was positive for p63, CK14, and CK7 and negative for SMA and S100. Ki-67 rate was 15.75%, confirming the diagnosis of malignant mucinous myoepithelioma. A head and neck surgeon performed the surgical resection of the tumor. No recurrence was observed after 5 months. Malignant mucinous myoepithelioma is a rare lesion that exhibits microscopic similarities with different entities, including other mucous-producing carcinomas, which makes its diagnosis a challenge. Support: CAPES, FAPEMIG.

Objectives: To investigate salivary biomarkers associated with bone remodeling and tissue repair in patients receiving radiotherapy. Study Design: Ethical approval (85229518.9.0000.5149). Patients previously subjected to radiotherapy of the head and neck were prospectively selected. Individuals who did not receive radiotherapy were paired by age and sex and composed the control group. Inclusion and exclusion criteria applied. Nonstimulated saliva was collected and processed for RANK, RANKL, OPG, endothelial growth factor (EGF), vascular endothelial growth factor (VEGF), and matrix metalloproteinase 9 (MMP-9) by enzyme-linked immunosorbent assay (ELISA). Paired t test and Wilcoxon test were used and P values .05). Patients receiving radiotherapy and chemotherapy (n = 16) had lower EGF than controls (P .05). Conclusion: Head and neck radiotherapy lowers the salivary concentrations of tissue repair factors, but not the bone remodeling factors. Support: CNPq, CAPES, FAPEMIG.

An 11-year-old patient, male, was submitted to orthodontic traction of enclosed lower molar. Tomographic examination showed a radiolucent image measuring approximately 1 cm between 46 and suggestive dental germ of the 47. Intraoral examination confirmed absence of the 46. The orthodontic traction was performed and a routine panoramic radiography revealed formation of a delineated radiolucent image with radiopaque foci at the periphery. Thereby, hypothesis of odontogenic lesions with a mixed radiographic appearance was made. A positive aspiration puncture for citrus yellow liquid was performed, followed by excisional biopsy. Microscopic findings revealed a cystic capsule lined by with odontogenic epithelium and numerous phantom cells permeated by areas of calcification. Moreover, the presence of dental tissues pointed to the diagnosis of calcifying odontogenic cyst associated with odontoma. Currently, the patient is in follow-up and radiographic images reveal new bone formation in the region. Financial support: CAPES.

A 64-year-old male patient presented an asymptomatic, long-lasting, submucosal enlargement at the right buccal mucosa. The lesion had a nodular appearance, was well circumscribed, was mobile, had a firm consistency, and was covered by clinically healthy mucosa. Ultrasonography revealed a hypoechoic, hypovascular, lobulated, and partially circumscribed lesion measuring 4.5 × 2.1 cm. The diagnostic hypotheses were epidermoid cyst or lipoma. The lesion was surgically excised under local anesthesia. During the excision, a dark-brown liquid drained out of the lesion. Histopathologic examination revealed a cystic lesion lined by a uniform, thin, parakeratinized epithelium with corrugated surface. The basal cell layer was hyperchromatic with nuclei palisade. The diagnosis was of odontogenic keratocyst. Panoramic radiograph revealed no bone involvement, and the patient showed no signs of Gorlin-Goltz syndrome. The patient is disease-free after 12 months of follow-up. Support: FAPEMIG.

Objective This study aimed to describe the morphologic characteristics of lip squamous cells carcinomas focusing in the invasive front and its association with tumor budding, and the presence of neutrophils and T lymphocytes. Study Design We included 43 surgical specimens of lip squamous cells carcinoma and classified them in accordance with a histologic invasive front grading system. Immunohistochemistry was performed for CD66b and CD3 for evaluation of neutrophils and T lymphocytes, respectively, in the invasive front of the tumors. Tumor budding was evidenced by AE1/AE3 staining. Results Thirty-six (83.7%) tumors were well-differentiated tumors. Eleven (25.6%) cases exhibited high-intensity tumor budding. There were low neutrophil and high T lymphocyte infiltrations in the invasive front, leading to a low neutrophil to T lymphocyte ratio in the same region. Moreover, we found an association between tumor budding and pattern of invasion, and also between CD3+ cell count and inflammatory infiltrate (P Conclusions The few cases showing high-intensity tumor budding, as well as the low neutrophil and high T-lymphocyte infiltration in the invasive front, are in accordance with the histopathological features of well-differentiated tumors. These morphologic parameters should be adjunct tools in the evaluation of lip squamous cell carcinomas. Support: FAPEMIG.

This cross-sectional study aimed to analyze the spatial distribution of patients with oral and oropharyngeal cancer in relation to specific vulnerability conditions (residential adequacy characteristics and minimum monthly income) and the access to public primary health care. A total of 136 medical records of patients referred to a department of head and neck surgery in a public hospital in Belo Horizonte from 2005 to 2015 were reviewed for sociodemographic features. The spatial distribution of the patients was analyzed using Ripley's K function and Kernel maps. Most patients were men (77.2%), white or brown (82.4%), married (36.8%), and with low educational level (72.1%); mean was 59.6 years. Oral cancer represented 54.4% of cases, and 45.6% were oropharyngeal. Most of the patients lived in the Northwest and North regions. Cancer cases showed an aggregate spatial pattern concentrated in areas with a higher number of citizens with no regular sanitary conditions and no monthly income or minimum monthly salary. A homogeneous distribution between cancer cases and public primary health care providers were observed. This study suggests that patients with oral and oropharyngeal cancer in Belo Horizonte are concentrated in clusters, and they live in regions with lower socioeconomic conditions. Supported by FAPEMIG

Objective To investigate the clinical and demographic characteristics of oral lymphoepithelial cyst. Study Design The files of an oral pathology service were reviewed for cases diagnosed as oral lymphoepithelial cyst. Data of patient sex, age, lesion location, clinical presentation, and clinical diagnosis were collected. Descriptive statistics were done. Results Forty-one cases of oral lymphoepithelial cysts were found among 36,359 archived specimens (0.11%). Lesions affected mainly women (73.2%) and persons of white ethnicity (53.7%), with a mean age of 46 years (range, 13-70), appearing mostly as an asymptomatic lesion at the tongue border (29.3%) and floor of the mouth (19.5%). Among 41 lesions, 25 (61%) measured less than 1 cm; 28 (68.3%) were whitish or had coloration similar to the surrounding mucosa. In 19 cases (46.3%), clinical diagnosis was not oral lymphoepithelial cyst, and fibrous hyperplasia and mucocele were commonly cited (12.2% each). Additionally, a case arising on the hard palate of a 69-year-old man is presented. Conclusion Oral lymphoepithelial cysts are uncommon lesions. The clinical and demographic data found herein are in accordance with previous reports. Support: FAPEMIG.

An 81-year-old male patient was referred to the stomatology service complaining of difficulty in prosthesis adapting. Clinically, a painless swelling was evident in the left maxilla. An incisional biopsy was performed and the specimen sent for histopathologic examination, revealing a final diagnosis of ameloblastoma. A computerized tomography (CT) scan was performed, revealing an extensive left maxillary lesion, involving the maxillary sinus and nasal cavity, crossing the midline and extending to the right side. During surgical planning, the use of the Weber-Ferguson-Diffenbach approach was raised, but it would not allow the recommended resection of the lesion since it exceeded past the midline. So, a midfacial degloving approach was chosen because this allows complete resection with safety margin and a better aesthetic result. The patient recovered well with good healing; no signs of recurrence were noted after 1 year of follow-up care. Thus, the degloving approach should be taken into account when treating extensive lesions in the midface. Support: FAPEMIG.

A 20-year-old white man was referred to the oral medicine clinic, complaining of an asymptomatic swelling in the upper lip lasting for around 2 years. His medical history included stress-induced gastritis, bronchitis, allergic rhinitis, and episodes of facial paralysis. The extraoral examination showed a large and diffuse swelling affecting the upper lip vermillion and labial mucosa causing facial asymmetry. The lesion was nonpitting, had a rubbery consistency, and presented with a normal temperature. The vermillion border was dried and stretched, with no ulceration. The intraoral examination revealed deep grooves and fissures on the tongue dorsum. A previous biopsy of the lip showed a chronic inflammatory area. Based on the history and clinical features, the diagnosis of Melkersson-Rosenthal syndrome was made. The patient is under treatment with intralesional infiltration of triamcinolone acetonide in the upper lip. Moreover, he was referred for a physician to investigate a possible intestinal involvement. Support: FAPEMIG.