Search

Objetivo: O objetivo do presente trabalho é relatar um fibroma ossificante periférico de grandes dimensões simulando clinicamente uma neoplasia maligna. Relato de caso: paciente de 35 anos, sexo feminino, foi encaminhada para avaliação de lesão exofítica, medindo 6,0 x 4,0 cm parcialmente ulcerada, avermelhada e sangrante, localizada na gengiva e mucosa alveolar superior a esquerda, com duração de 3 meses. Radiografias panorâmica e oclusal superior não mostraram alterações significativas e na tomografia computadorizada foram observadas calcificações no interior da lesão. O diagnóstico clínico incluiu Fibroma ossificante periférico e neoplasias produtoras de tecido mineralizado, incluindo osteossarcoma. Foi realizada biópsia incisional sob anestesia local e cortes de 5 µm corados com hematoxilina e eosina evidenciaram uma proliferação homogênea de células fusiformes associadas a áreas focais de calcificação coberta por epitélio de superfície parcialmente ulcerado. A remoção cirúrgica total da lesão realizada de forma conservadora sob anestesia local confirmou os achados histológicos encontrados no espécime da biopsia incisional e o diagnóstico de fibroma ossificante periférico. O controle clínico pós-cirúrgico mostrou a área totalmente cicatrizada e sem evidências de recidiva. Conclusão: neoplasias malignas podem eventualmente ser incluídas no diagnóstico diferencial clínico e imaginológico de condições inflamatórias reativas da cavidade oral e a avaliação histológica é mandatória para a confirmação diagnóstica. Objective: the aim of the present paper is to report a large peripheral ossifying fibroma (POF) clinically mimicking a malignant neoplasm. Case report: a 35 yearold female was referred for evaluation of a 6,0 x 4,0 cm reddish partially ulcerated and bleeding exophytic swelling situated in the upper left gingiva and alveolar mucosa, lasting 3 months. Panoramic and occlusal radiographs showed no alterations and computed tomograph scans showed the presence of calcified foci inside the lesion. Clinical diagnosis was peripheral ossifying fibroma and bone-producing neoplasms, including osteosarcoma. An incisional biopsy under local anesthesia was performed and the 5 ?m HE-stained sections revealed a homogeneous proliferation of spindle cells associated with areas of calcified tissue and covered by partially-ulcerated surface epithelium. Conservative complete surgical removal of the lesion was performed and analysis of the surgical specimen confirmed the histological features from the initial biopsy and the diagnosis of peripheral ossifying fibroma. Clinical follow-up showed the area totally repaired and no evidence of local recurrence. Conclusion: malignant neoplasms can be eventually included in the differential diagnosis of oral reactive inflammatory conditions and histological analysis is essential for proper diagnosis and management.

An 80-year-old male was referred for evaluation of an extensive swelling on the left side of the face lasting 1 year and with a previous diagnosis of nodular fasciitis. His medical history revealed arterial hypertension, aortic aneurysm, and partial carotid obstruction in clinical control. Clinical examination revealed a swelling in the left side of the face, with mild dystopia, associated with a swelling in the upper anterior and posterior left vestibule. Panoramic radiography showed no alteration in the region. Revision of the histologic slide from the previous biopsy was compatible with solitary fibrous tumor, and a new incisional biopsy was performed, confirming this histologic hypothesis. The patient was submitted to resection of the tumor, and the analysis of the surgical specimen confirmed the diagnosis of solitary fibrous tumor. The patient has been under clinical and radiographic follow-up for 6 months without evidence of local recurrence.

Fibromatosis is a benign locally aggressive spindle cell neoplasm that rarely affects the oral and perioral tissues. A 16-year-old adolescent boy was referred because of a swelling in the right mandibular angle lasting 1 month and progressive difficulties in mouth opening lasting 8 months. Regional examination showed a swelling in the right mandibular angle covered by normal skin and limited mouth opening. Panoramic radiograph and computed tomography revealed multilocular radiolucent lesion in the right mandibular angle. Clinical diagnosis included aneurysmal bone cyst, nodular fasciitis, and myxoma. Because of the location of the lesion, it was removed under general anesthesia with per-surgical frozen analysis. Provisional frozen diagnosis was a benign spindle cell neoplasm, and histologic and immunohistochemical analysis of the surgical specimen confirmed the diagnosis of aggressive fibromatosis. The patient has been followed up with no signs of local recurrence.

Kaposi sarcoma is a malignant neoplasm associated with human herpesvirus type 8 (HHV-8) infection that usually affects HIV-positive patients. A 34-year-old man was referred because of a swelling in the palate lasting 4 months that was initially interpreted and treated as an inflammatory endoperiodontal disease affecting teeth 21 and 22. Medical history revealed HIV infection. Physical examination revealed multiple purplish patches in the skin of the arms. Oral examination showed an exophytic reddish growth in the gingiva and palatal area close to the described teeth and a purplish patch in the left posterior hard palate. Periapical radiograph showed a radiolucent image involving the apexes of the aforementioned teeth. Clinical diagnosis was Kaposi sarcoma, and a biopsy was performed. Histologic analysis showed a proliferation of neoplastic HHV-8–positive spindle cells confirming the diagnosis of Kaposi sarcoma. The patient was referred to the infectious disease specialist, is currently under highly active antiretroviral treatment, and has been followed-up for the oral lesions.