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This systematic review purposed to investigate reports of oral lesions in confirmed COVID-19 patients summarizing clinical characteristics, histological findings, treatment and correlation of oral lesions and COVID-19 severity. Electronic search was conducted on November 2021 using seven databases to identify case reports/series describing lesions in oral mucosa in COVID-19 confirmed cases. A total of 5,179 studies were found, being 39 eligible from 19 countries, totalling 116 cases. It was observed only COVID-19 non-vaccinated cases and no sex or age predilection. The oral lesions presentation was mostly single location (69.8%), commonly in the tongue, lips, and palate, being ulcer the main clinical presentation. According to severity index for COVID-19, the reports were more frequent in patients with mild and moderate symptoms, being 75.8% in acute phase. The oral lesion appearance in post-acute COVID-19 were described after 14 to two months after patient recovery. Histologically, keratinocytes with perinuclear vacuolization, thrombosis and mononuclear inflammatory infiltrate were also described with the presence of the virus in keratinocytes, endothelial cells, and minor salivary glands. In conclusion, health care professionals should consider COVID-19 association when patient present ulcerated oral lesions and mild to moderate symptoms for COVID-19 or had acute-COVID-19.

The Inhibitor of Growth (ING) gene family is a group of tumor suppressor genes that play important roles in cell cycle control, senescence, DNA repair, cell proliferation, and apoptosis. However, inactivation and downregulation of these proteins have been related in some neoplasms. The present study aimed to evaluate the immunohistochemical profiles of ING3 and ING4 proteins in a series of benign epithelial odontogenic lesions. Methods: The sample comprised of 20 odontogenic keratocysts (OKC), 20 ameloblastomas (AM), and 15 adenomatoid odontogenic tumors (AOT) specimens. Nuclear and cytoplasmic immunolabeling of ING3 and ING4 were semi-quantitatively evaluated in epithelial cells of the odontogenic lesions, according to the percentage of immunolabelled cells in each case. Descriptive and statistics analysis were computed, and the p-value was set at 0.05. Results: No statistically significant differences were found in cytoplasmic and nuclear ING3 immunolabeling among the studied lesions. In contrast, AOTs presented higher cytoplasmic and nuclear ING4 labeling compared to AMs (cytoplasmic p-value = 0.01; nuclear p-value < 0.001) and OKCs (nuclear p-value = 0.007). Conclusion: ING3 and ING4 protein downregulation may play an important role in the initiation and progression of more aggressive odontogenic lesions, such as AMs and OKCs. Resumo Objetivos: A família dos Genes Inibidores de Crescimento (ING) é um grupo de genes supressores tumorais que desempenham papéis importantes no controle do ciclo celular, na senescência, no reparo do DNA, na proliferação celular e na apoptose. No entanto, a inativação e a regulação negativa dessas proteínas têm sido relacionadas em algumas neoplasias. O objetivo do presente estudo foi avaliar o perfil imuno-histoquímico das proteínas ING3 e ING4 em uma série de lesões odontogênicas epiteliais benignas. Métodos: A amostra foi composta por espécimes de 20 ceratocistos odontogênicos (CO), 20 ameloblastomas (AM) e 15 tumores odontogênicos adenomatoides (TOA). A imunoexpressão nuclear e citoplasmática de ING3 e ING4 foram avaliadas semi-quantitativamente nas células epiteliais das lesões odontogênicas, de acordo com a porcentagem de células imunomarcadas em cada caso. As análises descritivas e estatísticas foram computadas, e o valor de p estabelecido foi de 0,05. Resultados: Não foram encontradas diferenças estatisticamente significativas na imunoexpressão citoplasmática e nuclear de ING3 entre as lesões estudadas. Em contrapartida, os TOAs apresentaram maior marcação citoplasmática e nuclear de ING4 em comparação aos AMs (valor de p citoplasmático=0,01; valor de p nuclear

Introducao: O Liquen Plano e uma doenca mucocutânea imunomediada, de natureza cronica inflamatoria e etiologia desconhecida, onde a cavidade oral e um dos locais mais comumente afetados, sendo assim denominado de Liquen Plano Oral (LPO). O LPO, geralmente, acomete mulheres com idade entre 30 e 60 anos, e pode se apresentar como uma lesao semelhante a placa, ou com aspecto reticular, erosivo, atrofico, papular ou bolhoso. Objetivo: Relatar um caso de LPO, com presenca de multiplas lesoes que apresentam diferentes aspectos clinicos. Relato de caso: Paciente do sexo feminino, feoderma, de 50 anos de idade, procurou o servico de diagnostico oral da UFRN se queixando de ardencia no ceu da boca. Durante a anamnese a paciente relatou ser ex-tabagista e ter problemas de ansiedade. No exame intraoral observou-se uma lesao ulcerada em palato duro, como tambem a presenca de lesoes bilaterais em mucosa jugal que apresentavam aspecto reticular, entretanto essas nao exibiam sintomatologia. O diagnostico clinico de LPO foi emitido. A biopsia excisional da lesao em palato foi realizada, onde o diagnostico histopatologico corroborou com o clinico. A paciente se encontra sob acompanhamento clinico. Conclusao: O paciente com LPO deve ser acompanhado rotineiramente, visto que muitas vezes as lesoes orais antecedem as manifestacoes extraorais, sendo o cirurgioes-dentistas um agente importante no diagnostico dessa doenca, o que possibilita a realizacao de um tratamento adequado. Liquen oral plan: case report with different clinical aspects

The glandular odontogenic cyst (GOC) is a rare jaw development cyst that exhibits aggressive biological behavior and is prone to recurrence. The present study aims to report a case of GOC with an emphasis on its clinical, diagnostic, and therapeutic aspects. A 40-year-old female patient presented to the Buccomaxillofacial Surgery service with a swelling in the anterior mandible. Histopathological analysis revealed a cystic cavity lined by a non-keratinized epithelium of varying thickness, exhibiting many features consistent with GOC, such as mucous cells and duct-like microcystic spaces. Lesion resection was performed, followed by immediate reconstruction. After one year of follow-up, the patient is free of recurrence. Therefore, this case highlights the importance of an effective diagnosis of GOC, through a clear definition of histopathological criteria, to provide the most appropriate treatment and absence of relapses.

Background: Osteosarcoma is a malignant neoplasm that occurs most often in long bones, with the head and neck region being rarely affected, accounting for less than 1% of all cancers in this region. Objective: To report a rare case of a large-extension osteosarcoma with emphasis on its clinical and diagnostic aspects. Case presentation: A 43-year-old woman presenting an intraoral exophytic lesion with involvement of other maxillofacial structures, such as nostril, zygoma and orbit. Despite the initial clinical diagnosis of actinomycosis, an incisional biopsy confirmed the histopathological diagnosis of osteosarcoma, showing a wide morphological variety. Conclusion: This case highlights the importance of clinical and histopathological findings for the correct diagnosis of osteosarcoma. Moreover, it shows that, although surgical resection is the primary treatment for this neoplasia, depending on the extent of the tumor and its proximity to vital anatomical structures, the most appropriate conduct is not always feasible. Introducción: El osteosarcoma es una neoplasia maligna que se presenta con mayor frecuencia en huesos largos, siendo raramente afectada la región de cabeza y cuello, lo que corresponde a menos del 1% de todos los cánceres de esa región. Objetivo: Reportar un caso raro de osteosarcoma a gran escala, con énfasis en sus aspectos clínicos y diagnósticos. Presentación del caso: mujer de 43 años que presenta una lesión intraoral exofítica con afectación de otras estructuras maxilofaciales, como fosa nasal, cigoma y órbita. A pesar del diagnóstico clínico inicial de actinomicosis, la biopsia incisional confirmó el diagnóstico histopatológico de osteosarcoma, presentando una amplia variedad morfológica. Conclusión: El caso clínico destaca la importancia de los hallazgos clínicos e histopatológicos para el correcto diagnóstico del osteosarcoma. Además, muestra que, si bien la resección quirúrgica es el tratamiento primario de esta neoplasia, dependiendo de la extensión del tumor y su proximidad a estructuras anatómicas vitales, el abordaje más adecuado no siempre es factible. Introdução: O osteossarcoma é uma neoplasia maligna que ocorre mais frequentemente em ossos longos, sendo a região da cabeça e pescoço raramente afetada, correspondendo a menos de 1% de todos os cânceres nessa região. Objetivo: Relatar um caso raro de osteossarcoma de grande extensão, com ênfase em seus aspectos clínicos e diagnósticos. Apresentação do caso: Mulher de 43 anos apresentando lesão exofítica intraoral com envolvimento de outras estruturas maxilofaciais, como narina, zigoma e órbita. Apesar do diagnóstico clínico inicial de actinomicose, a biópsia incisional confirmou o diagnóstico histopatológico de osteossarcoma, apresentando uma grande variedade morfológica. Conclusão: O caso clínico destaca a importância dos achados clínicos e histopatológicos para o diagnóstico correto do osteossarcoma. Além disso, mostra que, embora a ressecção cirúrgica seja o tratamento primário dessa neoplasia, dependendo da extensão do tumor e de sua proximidade com estruturas anatômicas vitais, a conduta mais adequada nem sempre é viável.

The present study aimed to report a case of mucoepidermoid carcinoma (MEC), focusing on its clinical-pathological characteristics. At intraoral clinical examination, a nodular lesion was observed in the right pterygomandibular raphe region, with three years of evolution. An incisional biopsy was performed, and the diagnostic hypotheses of salivary gland injury and sialadenitis were considered. Histopathologically, a malignant neoplastic process characterized by the proliferation of epidermoid, intermediate and mucosal cells was observed. The histopathological diagnosis of MEC was emitted. The present case praises the importance of early diagnosis and correct management of this disease, providing a better prognosis for these patients.

A 10-year-old female patient presented volume increase in the posterior region of the mandible, with expansion of the cortical bone and absent symptoms. The lesion was located in the region of the dental elements 47 and 48, which were included. Radiographically, we observed a multilocular radiolucent osteolytic lesion with well-defined limits. The excisional biopsy was performed, obtaining the histopathologic diagnosis of ameloblastic fibroma. Histologically, this lesion is characterized by the proliferation of both epithelial and mesenchymal components, with the presence of islands, cords, and follicles of odontogenic epithelium, immersed in ectomesenchyme mimicking the dental papilla. The ameloblastic fibroma consists of a rare benign odontogenic tumor that usually occurs between the first and second decades of life, with the mandibular posterior region being most affected. This case praises the importance of an effective diagnosis to provide adequate and conservative treatment in lesions such as ameloblastic fibroma.

A 40-year-old female patient attended the oral and maxillofacial surgery service with complaint of an increase in volume in the anterior region of the mandible. With a time of evolution of 6 months, the region of the lesion presented blue coloration, hardened consistency, and painful symptomatology, measuring approximately 4 cm. Displacement of dental elements (31, 32, and 33) was evidenced. Radiographically, a multilocular radiolucent osteolytic lesion was observed. Diagnostic hypotheses were given for odontogenic keratocysts and botryoid cyst. The incisional biopsy was performed, obtaining the histopathologic diagnosis of glandular odontogenic cyst. The patient was submitted to excisional biopsy, confirming the previous histopathologic diagnosis. Due to the aggressiveness and the high recurrence rate inherent to this lesion, segmental resection of the lesion was performed, followed by block graft reconstruction. This case highlights the importance of an effective diagnosis to provide adequate treatment and absence of relapses.

A 72-year-old female patient attended the stomatology clinic complaining of swelling in the region of the left jugal mucosa and a time of evolution of 6 months. On physical examination, a symptomatic increase in volume of hardened palpation was observed, measuring approximately 2.5 cm in length. After the ultrasonography of the region was requested, the patient was referred to the buccomaxillofacial surgery department. The clinical diagnosis of pleomorphic adenoma was established, and the excisional biopsy was performed. Histopathologic examination revealed a malignant neoplasm of lymphoid origin, requiring a complementary immunohistochemical report. Associating the morphologic findings with the immunohistochemical results of Bcl2, CD5, CD10, CD15, CD20, CD23, Cyclin D1, Ki-67, the diagnosis was follicular lymphoma, and the patient is still under treatment. Non-Hodgkin’s lymphoma is a malignant neoplasm that affects the head and neck region, and its classification is extremely important for treatment and prognosis.

Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease that often affects the anogenital area; oral mucosal lesions are extremely rare. A 52-year-old woman presented for evaluation of an 8-year history of a persistent whitish plaque in the buccal mucosa. Intraoral examination revealed multiple elevated whitish plaques diffusely distributed in the buccal mucosa associated with an area of tissue atrophy. Although both leukoplakia and lichen planus were considered, incisional biopsy and later, full excision confirmed the histopathological diagnosis of oral LS. After 6 months of follow-up, there are no clinical signs of relapse. This case highlights the importance of clinical and histopathological findings for the correct diagnosis and treatment of oral LS.

A 36-year-old male, smoker, reported having been a cocaine user for 2 years. He was sent to the Surgery and Traumatology department of a reference hospital and, at clinical examination, a necrotic lesion was observed in the oral mucosa of the left side with absence of painful symptoms and presence of perforation in the hard palate. The diagnostic hypothesis of oral squamous cell carcinoma was considered. Excisional biopsy was performed in all areas involved in the lesion, including left nostril and periorbital and anterior maxilla regions. He was given a histopathological diagnosis of tissue necrosis associated with non-specific mixed inflammatory process. Despite this, it is necessary to investigate a possible association to infectious conditions resultant from the use of cocaine. In addition, the hypothesis of malignant lymphoid origin cannot be ruled out. This case illustrates the importance of correlating histopathological, imaging, and laboratory characteristics for an adequate diagnosis.

A 56-year-old male patient, smoker, attended the buccomaxillofacial surgery sector with complaint of volume increase located in the left submandibular region with an evolution time of 10 years. At the physical examination, a soft palpation-like lesion was observed, asymptomatic, measuring approximately 6 cm in length. After tomographic examination, an image suggestive of tumor lesion was identified, which was well delimited, oval, hypodense, and located in superficial tissue planes in the left submandibular region. Thus, the clinical hypothesis of lipoma was considered. All preoperative examinations and surgical risk were performed. The patient underwent excisional biopsy under general anesthesia, and through histopathologic analysis the clinical hypothesis was confirmed. Although lipoma represents a common mesenchymal neoplasm, its presence in the submandibular region is extremely rare, accounting for only 1% to 2% of all lipomas in the body.

A 35-year-old female patient attended the oral diagnostic service presenting with a lesion on the attached gingiva, in the region of dental elements 31 and 32. The lesion presented a red-blackish coloration, softened consistency, sessile implantation, and exophytic growth, measuring approximately 4 mm. An excisional biopsy was performed, and the diagnostic hypotheses of hemangioma and angiofibroma were considered. During microscopic examination, there was proliferation of nevus cells, organized in theques arrangements, exhibiting a certain degree of pleomorphism, hyperchromatism, and sometimes bizarre appearance. From the immunohistochemical analysis for HMB-45, Melan-A, S-100, and Ki-67 antibodies, the histopathologic diagnosis of dysplastic melanocytic nevus was given. This case emphasizes the importance of the association of clinical, histopathologic, and immunohistochemical characteristics to obtain an adequate diagnosis, to rule out any other lesions.

The aim of this study was to evaluate morphologically oral epithelial dysplasias (EDs) and consolidate a discussion about the classification of these conditions using the classification methods proposed by the World Health Organization (WHO, 2005) and by the binary system of Kurjan et al. (2006). This is an observational, descriptive-analytical study. The sample consisted of 60 specimens of hyperkeratosis and ED, which were morphologically evaluated and classified according to classification systems of ED proposed by WHO (2005) and Kujan et al. (2006). To verify if there is an association between the highest degree of malignancy proposed by Kurjan and the more advanced degrees of ED proposed by the WHO, the chi-square test (P ≤ .05) was performed. Analysis of oral ED according to the classification has shown that there is a positive association of the increased risk of malignancy with moderated or severe ED. This study emphasizes the clinical relevance of using a simpler and more efficient gradation system, taking into account that the binary system proposed by Kurjan et al. (2006) presents greater objectivity in the evaluation and classification of these disorders.

A 72-year-old female patient attended the dental office with a complaint of tongue lesion and a time course of 3 months. At the physical examination, a nodular lesion was found, located on the back of the tongue, with mucosa-like staining, firm consistency, sessile implantation, measuring approximately 1.5 cm. Considering the clinical findings, the diagnostic hypothesis was granular cell tumor, and the excisional biopsy performed. The histopathological examination showed regions of cartilaginous matrix and newly deposited bone matrix without cellular alterations and the diagnosis of choristoma was established. The choristoma is a growth like a tumor, exhibiting microscopically normal tissue in an abnormal location. They are benign and rare lesions, showing great predilection for the tongue, mainly posterior region in 85% of the cases. In 70% of cases of oral choristoma the patients are female.

Introduction: Oral lichen planus (LPO) is a relatively common chronic inflammatory disease whose etiopathogenesis is still not fully understood. Objective: To assess the expression of nuclear factor kappa B (NFkB) in specimens of oral lichen planus reticularis (30 cases), erosive lichen planus (10 cases), and 15 cases of inflammatory fibrous hyperplasia. Study Design: Immunohistochemical analysis to investigate differences in the expression of NFkB, using the methodology adapted from Al-Hashimi et al. (2018). Results: It was observed that in relation to the expression of NFkB, no statistically significant difference was found in the epithelial lining in connective tissue this protein was lower than in the case OLP when compared with control.Conclusion: It can be concluded that the presence of epigenetic changes in the immune system trigger the inflammatory pathogenesis of adjuvant LPO.

Lichen sclerosus (LS) is a chronic inflammatory mucocutaneous disease that often affects the anogenital area; oral mucosal lesions are extremely rare. A 52-year-old woman presented for evaluation of a persistent whitish plaque in the buccal mucosa with an 8-year evolution. Intraoral examination revealed multiple, elevated, whitish lesions diffusely distributed in the buccal mucosa associated with an area of tissue atrophy. Under the diagnostic hypothesis of leukoplakia or lichen planus, incisional biopsy was performed, obtaining the histopathologic diagnosis of oral LS. The patient was referred to the dermatologist and gynecologist for investigation of possible skin and genital lesions, respectively. Because of the time of evolution of the lesion, total surgical excision was performed, and the previous histopathologic diagnosis was confirmed. After 6 months of follow-up, there are no clinical signs of relapse. This case highlights the importance of clinical and histopathologic findings for the correct diagnosis and treatment of oral LS.

Objectives To evaluate the expression of TWIST and E-cadherin in lower-lip squamous cell carcinoma (LLSCC) and their association with clinical-pathologic parameters. Study Design A total of 59 LLSCC cases diagnosed were included in the present study. Histopathologic malignancy grading by Almagush et al. (2014) and immunohistochemical analyses followed a blind method. The collected data were submitted for statistical analysis. Results LLSCC in the early clinical stages exhibited higher median values for general (P = .035) and membrane E-cadherin expression (P = .022) compared to tumors classified in more advanced stages. Higher expression of E-cadherin (general and membrane) was observed in cases with disease-free survival after 5 years of follow-up (P Conclusions The results of the present study suggest the potential involvement of TWIST and E-cadherin in the modulation of events related to worse LLSCC prognoses.

A 43-year-old female patient attended the oral maxillofacial and traumatology service presenting volume increase in the right hemiface with painful symptomatology. At the intraoral examination, an exophytic lesion involving the alveolar ridge and palate region was observed, extending to the right nostril. The lesion showed a partially ulcerated surface, with purulent secretion, firm consistency, and normal mucosal color. Computed tomography revealed a mixed appearance of hyperdensity and ill-defined hypodensity in the maxillary region with extension to the zygoma and the right orbit. Because of poor oral hygiene and a history of regression with antibiotic therapy, a clinical diagnosis of actinomycosis was issued, and incisional biopsy of the lesion was subsequently performed. In the microscopic analysis, proliferation of pleomorphic and atypical malignant mesenchymal cells was associated with deposition of osteoid matrix, thus confirming the histopathologic diagnosis of osteosarcoma. The patient was referred to the State Reference Center for appropriate treatment.

Objective: To conduct a retrospective study on a series of cases of PV and BMMP with manifestations in the oral cavity in order to ascertain prevalence, sociodemographic characteristics, diagnostic maneuvers, treatment and follow-up. Methods: This is a retrospective, descriptive study in which clinical data were collected from the medical records of all cases of PV and BMMP registered and diagnosed, between 1995 and 2015, in the Oral Diagnostic Service of the UFRN Department of Dentistry. Results: The mean age of the total sample (n = 36) was 41.64, with females the most frequent (n = 26; 72.22%) and the cheek mucosa being the site most affected (n = 20; 27.40%). Eight patients (22.22%), including 5 cases of PV and 3 BMMP, were clinically reevaluated. All patients exhibited lesions at the time of follow-up. Prednisone (n=7; 87.5%) and clobetasol propionate (n=8, 100%) were the most widely used drugs in the systemic and topical treatment, respectively. The follow-up period ranged from 5 months to 5 years. Conclusion: The clinical profile of patients in this study was similar to that evidenced in the literature. However, it was found that the oral lesions were more resistant to the treatment used on the patients evaluated. RESUMO Objetivo: Realizar um estudo retrospectivo em uma série de casos de PV e BMMP com manifestações em cavidade oral com o intuito de verificar suas prevalências, características sociodemográficas, diagnóstico, tratamento e acompanhamento. Métodos: Trata-se de um estudo retrospectivo descritivo no qual os dados clínicos foram coletados a partir dos prontuários de todos os casos de PV e BMMP registrados e diagnosticados, entre 1995 e 2015, no serviço de Diagnóstico Oral do Departamento de Odontologia da UFRN. Resultados: Da amostra total (n=36), a age média foi de 41,64 anos, sendo o sexo female o mais frequente (n=26; 72,22%) e a mucosa jugal o sítio mais afetado (n=20; 27,40%). Oito pacientes (22,22%), dos quais 5 são casos de PV e 3 de BMMP, foram reavaliados clinicamente. Todos os pacientes exibiram lesões no momento do acompanhamento, sendo a prednisona (n=7) e o propionato de clobetasol (n=8) os fármacos mais utilizados no tratamento sistêmico e tópico, respectivamente. O tempo de acompanhamento variou de 5 meses a 5 anos. Conclusão: O perfil clínico dos pacientes da presente pesquisa foi semelhante ao da literatura. No entanto, verificou-se que as lesões orais foram mais resistentes ao tratamento empregado nos pacientes avaliados.