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A 57-year-old woman was referred to our service for the assessment of a nodular lesion in the oral mucosa that exhibited spontaneous bleeding. According to the patient, the lesion had been present for five years. Over the past year, she had experienced multiple episodes of significant bleeding and struggled to control the hemorrhage. Her medical history included episodes of nosebleeds (epistaxis) and spontaneous skin hematomas. During the extraoral examination, petechiae were observed on her face. Upon intraoral examination, a purplish submucosal nodule measuring approximately 1.5 x 1.0 cm was identified in the upper lip mucosa. Following the clinical assessment, hematological tests were ordered. While the red and white blood cell counts were within the normal range, the results revealed a severe thrombocytopenia characterized by a low platelet count. Additionally, reduced prothrombin activity was detected. The patient was subsequently referred to a hematologist, who diagnosed idiopathic thrombocytopenic purpura. After the diagnosis, the patient initiated hematological treatment and is currently under clinical follow-up with our interdisciplinary team. [ABSTRACT FROM AUTHOR]

The range of microscopic features seen in salivary gland tumors can sometimes lead to misdiagnosis. In this case, a 63-year-old woman with no comorbidities was referred to a healthcare service for an evaluation of a lesion on her hard palate. The patient had a previous pathology report indicating a diagnosis of Pleomorphic Adenoma. During the extraoral examination, no abnormalities were observed. However, intraoral physical examination revealed an ulcerated lesion measuring approximately 1 cm on the left side of the hard palate. Imaging tests were performed and showed no significant changes in the region of the lesion. Given the clinical features of the lesion that raised concerns about malignancy, a review of the slides from the previous biopsy sample was requested. Upon review, the microscopic features indicated malignancy, leading to the diagnosis of Adenoid Cystic Carcinoma. The patient was informed about the diagnosis and subsequently referred to oncological treatment with an interdisciplinary team. This case illustrates the importance of careful review and accurate diagnosis, as the initial diagnosis of a benign lesion was revised to a malignant condition, which required a different treatment approach. [ABSTRACT FROM AUTHOR]

Subgemmal neurogenous plaque is a regional anatomic variation characterized by the presence of ganglion cells in a subepithelial nerve plexus close to the taste buds of the tongue. A 40-year-old female patient was referred for evaluation due to a burning sensation on the right lateral border of her tongue, which had been bothering her for the past 9 months. Upon intraoral examination, an erythematous area and hyperplastic foliate papillae were observed on the left lateral border of her tongue. The initial diagnostic considerations included foliate papillitis and subgemmal neurogenic plaque. Subsequently, the lesion was surgically removed, and a histopathological examination, along with immunohistochemical staining for S100, was conducted. Microscopically, the lesion exhibited a superficial layer that resembled a neurofibroma-like proliferation running parallel to the surface epithelium, and a deeper area composed of tortuous neuronal bundles with ganglion cells, similar to a neuroma-like lesion. This supported the diagnosis of subgemmal neurogenic plaque. The patient remained asymptomatic at a 9-month follow-up. [ABSTRACT FROM AUTHOR]

An 89-year-old female patient was admitted to our center for the evaluation of a painful ulcer in the palatine mucosa. She reported that the ulcer had been present for 20 days, and during this time, she had inadvertently traumatized the region with a hairpin in an attempt to relieve the pain caused by the ulcer. Upon intraoral examination, we observed a painful ulcer in the palatine mucosa, adjacent to teeth 25, 26, and 27. The ulcer measured approximately 2.0x1.0 cm, featured well-defined boundaries, and slightly raised edges. Considering diagnostic possibilities of an inflammatory ulcer, granulomatous infection, or malignant neoplasm, a biopsy was performed. Histopathological examination revealed an ulcerated lesion with a fibroleukocyte crust, the presence of a moderate inflammatory infiltrate, both superficial and deep, with an abundance of eosinophils, and proliferative vessels throughout. The final diagnosis confirmed the condition as an eosinophilic ulcer of the oral mucosa. Notably, a partial healing process was observed three weeks after the surgical procedure. This case underscores the importance of considering eosinophilic ulcers in the differential diagnosis of extensive oral lesions. [ABSTRACT FROM AUTHOR]

Odontogenic fibromyxoma (OF) is a benign mesenchymal tumor considered a variant of odontogenic myxomas. Typically, OF predominantly affects the mandible, manifesting as painless swelling. This tumor is more commonly found in adolescents and young adults, with rare occurrences in children. A 17-month-old boy was referred for an evaluation due to a swelling in the middle third of the right side of his face, which had been progressing for three weeks. A computed tomography scan revealed a circular hypodense image measuring approximately 3 x 2 cm. Based on the imaging and clinical findings, a benign maxillary odontogenic tumor was suspected, leading to the decision to surgically remove the lesion. Microscopic analysis of the removed tissue revealed spindle-shaped cells within a myxoid background, with alcian blue staining confirming the diagnosis of odontogenic fibromyxoma. This case report highlights the importance of considering odontogenic fibromyxoma in the differential diagnosis of rapidly growing tumors in young children. [ABSTRACT FROM AUTHOR]

Oral ulcers induced by medications are a well-recognized but often underappreciated adverse reaction to drug use. Clinically, they often present as "aphthous-like" lesions accompanied by painful symptoms. While numerous medications are known to trigger oral lesions, there have been relatively few reported cases of antidepressant-induced oral lesions. A 63-year-old female was referred for an investigation into painful ulcers that had appeared on the lateral border of her tongue and the floor of her mouth two months prior. She was taking nine different medications for various health conditions, including two antidepressants (Amitriptyline and Fluoxetine), without proper medical supervision. An incisional biopsy was performed, and histopathological analysis revealed moderate mononuclear inflammatory infiltrates beneath the epithelium. The clinical diagnosis indicated drug-induced oral ulcers, and the antidepressants were substituted with appropriate psychiatric support. After three months, the ulcers had completely healed. This case underscores the importance of considering adverse reactions to antidepressants as a potential cause of inflammatory oral ulcers in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Condyloma acuminatum typically occurs more frequently in teenagers and young adults and is relatively rare in elderly patients. However, an 81-year-old woman was referred to our service for the evaluation of a lesion on the left side of her tongue. According to the patient, the lesion first appeared three years ago and has progressively increased in size over time. Her medical history was notable for hypertension, cardiac arrhythmia, arthrosis, osteoporosis, and gastritis. Importantly, she was a non-smoker and did not consume alcohol. During the intraoral examination, a prominent nodular lesion with a sessile base and multiple papillary projections, displaying white, pink, and reddish areas, was observed. The diagnostic possibilities included condyloma acuminatum, papilloma, verrucous carcinoma, and squamous cell carcinoma. A biopsy was conducted, and microscopic evaluation revealed parakeratinized epithelium with acanthosis, blunt projections, and the presence of koilocytosis, which supported the diagnosis of oral condyloma acuminatum. The patient was treated through surgical excision performed under local anesthesia. A one-year follow-up examination showed no signs of lesion recurrence. [ABSTRACT FROM AUTHOR]

A 75-year-old female patient was referred to our service for the evaluation of a tongue lesion that she had been experiencing for over 20 years. Her medical history did not indicate a history of smoking or alcoholism. Upon intraoral examination, a vegetating ulcer was observed on the lateral edge of the tongue. A clinical diagnosis of squamous cell carcinoma (SCC) was suspected, and two biopsies were performed at different times. Histological examination of the biopsies revealed epithelium with hyperkeratosis and acanthosis, along with mild epithelial dysplasia. However, when the lesion was surgically removed under general anesthesia, microscopic analysis confirmed the presence of invasive SCC. The patient is currently under clinical monitoring, and there has been no recurrence in the 7-month follow-up period. [ABSTRACT FROM AUTHOR]

Osteoma is an infrequently encountered benign osteogenic tumor within the paranasal sinuses. An 85-year-old woman, afflicted by diabetes and Alzheimer's disease, was referred to our medical facility to assess a painful swelling in the middle third of her face that had been progressing for approximately five years. Upon external examination, a periorbital swelling with a firm consistency was observed on the left side. Consequently, a computed tomography of the paranasal sinuses was ordered. The imaging sections revealed a hyperdense image within the left ethmoid sinus, indicating the presence of a substantial osteoma. This tumor originated from the ethmoid bone and exerted pressure on the walls of the orbital cavity and maxillary sinus. Additionally, it displayed significant extension into the nasal cavity on the same side. The patient underwent a lateral rhinotomy procedure for tumor removal. Subsequent histopathological analysis confirmed the presence of an osteoma comprised of mature lamellar tissue. The patient continues to be under the care of our multidisciplinary team, and a one-year follow-up examination exhibited no indications of tumor recurrence. [ABSTRACT FROM AUTHOR]

Ulcerations are characterized by defects in the epithelium, underlying connective tissue, or both. Due to a diversity of causative factors and clinical features, diagnosis of oral ulcerative lesions can be quite challenging. Here we present a case of 34-year-old woman, nonsmoker, nondrinker, who had a painful, nonhealing ulcer located on the tongue (right side) that had first appeared 2 months earlier. Intraoral examination revealed an ulcer measuring 4 mm × 2 mm with a fibrous center and hardened margin. Teeth 44 and 45 were pointed, which caused occlusal trauma to the right lateral edge of the tongue. After reviewing the historical case and appropriate clinical examination, the patient was diagnosed with a chronic traumatic ulcer. Thus, smoothing of the cuspids was the chosen treatment of the teeth involved. A gradual decrease of the traumatic ulcer was observed. The patient has been under clinical follow-up without symptomatology for 6 months. [ABSTRACT FROM AUTHOR]

Primary lymphomas of the oral cavity are rare, and the most common type is diffuse large B-cell lymphoma (DLBCL). A 77-year-old man was referred for evaluation of a palate lesion with 2 months of evolution. Extrabuccal examination showed no abnormalities. Intraoral examination revealed swelling on the right side of the hard palate, with a fibrous consistency, ulcerated surface, painless, and mobility of the upper posterior teeth. Panoramic radiography and computed tomography showed extensive bone destruction on the right side of the maxilla. The diagnostic hypothesis was malignant mesenchymal tumor. Biopsy was performed, and histopathology was suggestive of leishmaniasis. The DNA polymerase chain reaction technique did not identify the presence of the protozoan. A new biopsy was performed and microscopic findings were suggestive of hematopoietic neoplasm. Immunohistochemical analysis revealed positivity for CD20, Bcl2, Bcl6, Ki-67, MUM1, confirming the diagnosis of DLBCL. The patient underwent chemotherapy and is in clinical follow-up. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma of the maxillary sinus (SCCMS) is a rare neoplasm and is often diagnosed in advanced stages because of a lack of typical symptoms. Here we present the case of a 66-year-old male smoker and ex-drinker, diagnosed with and treated for recurrent sinusitis for 1 year, according to patient report. Extrabuccal examination showed slight swelling on the right side of the third middle face with continuous nasal discharge on the same side. Intraoral examination revealed maxillary swelling on the right side and an extensive ulcer affecting the alveolar ridge, hard palate, and soft palate. The ulcer extended beyond the midline and had a necrotic bed and spontaneous bleeding. Computed tomography showed extensive bone destruction involving the orbit, maxillary sinus, and maxilla on the direct side. Under the hypothesis of SCCMS, a biopsy was performed. The histopathologic findings confirmed the diagnosis of SCCMS. The patient was referred for cancer treatment. [ABSTRACT FROM AUTHOR]

The blastoid variant of mantle cell lymphoma (MCL) is a rare and aggressive subtype of B-cell non-Hodgkin's lymphoma. A 73-year-old man was referred for clinical evaluation of an extensive lesion in the right palatine tonsil. The patient reported dysphagia and that the lesion had 2 months of evolution. Intraoral examination displayed a nodular mass of flaccid consistency measuring about 4 × 4 cm with areas of ulceration. A biopsy was performed under local anesthesia. Histopathologic examination revealed a hyperplasia of tonsillar lymphoid tissue suggestive of lymphoma. Immunohistochemistry reactions were positive for CD20 (L26), Bcl2 (124), cyclin D1 (EP12), CD5 (4C7), and Ki-67 (MIB-1; 90%) and negative for CD3 (polyclonal), Bcl6 (PG-B6p), and MUM1 (MUM1p). These findings led to the diagnosis of blastoid variant of MCL. The patient was referred to a specialist to start onco-hematological treatment. Patient monitoring is being performed by our multidisciplinary oncology team. [ABSTRACT FROM AUTHOR]

Focal oral mucinosis (OFM) is a rare lesion of unknown etiology that exhibits tumor growth. OFM has a predilection for keratinized tissues, such as the gingiva or hard palate. The occurrence of OFM in nonadherent oral mucosa is rare. Here we present the case of a 47-year-old woman, nonsmoker, nonalcoholic, with no history of facial trauma. On extrabuccal examination, no changes were observed. On intraoral examination, a 10 × 10 mm yellow submucosal rounded nodule was observed in the lower midline fornix region, fibrous on palpation, covered by thin and normal mucosa. On occlusal radiography, no bone destruction was observed. Excisional biopsy was performed. Histomorphologic analysis showed myxoid connective tissue with abundant mucinous material with delicate collagen fibrils. The diagnosis of OFM was established by staining with Alcian blue, period acid-Schiff stain, and immunohistochemistry for protein S-100. In 1 year of follow-up, there was no recurrence. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity. We report an unusual case of a 60-year-old white woman, a nonsmoker and nondrinker, who presented 2 lesions in the oral cavity at the same time in the first clinical examination. The first one was on the right side of the mouth floor and the second one on the left side of buccal mucosa with different clinical characteristics. The lesion in the mouth floor shows as an extensive ulcer of indefinite limits of granular to necrotic, whereas the lesion in the buccal mucosa presents as a white exophytic ulcer with a verrucous appearance. Both lesions presented exophytic with verrucous aspect, mixed coloration, and indefinite limits. After the incisional biopsy of both areas, histopathology examination identified the lesions as SCC. The patient was referred for treatment at the oral oncology center. [ABSTRACT FROM AUTHOR]

Regional odontodysplasia (RO) is a rare developmental dental anomaly with a prevalence of less than 1 in 1,000,000 in humans. The main objective of the present work is to present imaging aspects of RO. A 13-year-old female patient was referred to the radiology clinic for panoramic radiography and cone beam computed tomography. In these examinations all the teeth in the left maxilla and the tooth 11 showed alteration in size and shape of the crown and root. The affected teeth had the appearance of "ghost teeth," with a reduction in enamel thickness and density in addition to large pulp chambers and open apices. Usually, the teeth presented developmental delay and eruption in relation to the corresponding ones on the contralateral side. The alterations identified in the imaging tests suggest a diagnosis of RO. The proposed treatment was conservative until the period of bone maturation. [ABSTRACT FROM AUTHOR]