Fibroelastic Consistency Research Articles

SCHWANNOMA IN THE LOWER LIP: A CASE REPORT

Schwannoma is a benign tumor derived from Schwann cells. About 25% of all schwannomas are diagnosed in the head and neck region, but only 1% in the oral cavity. The intraoral lesions show a predilection for the tongue, followed by palate, buccal mucosa, and lip. A 26-year-old male was referred, complaining of a "cyst on the lower lip" which began 5 years ago. Intraoral examination showed a painless nodule, normal color, smooth surface, and fibroelastic consistency, located on the lower lip. An excisional biopsy was performed, and histopathological examination showed a well-circumscribed, encapsulated tumor with a predominantly typical Antoni A pattern, present throughout the tumor. Immunohistochemical analysis showed positive results for S100, CD56, and CD34. The diagnosis of Schwannoma was established. The patient is undergoing follow-up, with no signs of lesion recurrence after 1 year. Schwannoma should be considered in the differential diagnosis of nodular lesions on the lip. Schwannoma is a benign tumor derived from Schwann cells. About 25% of all schwannomas are diagnosed in the head and neck region, but only 1% in the oral cavity. The intraoral lesions show a predilection for the tongue, followed by palate, buccal mucosa, and lip. A 26-year-old male was referred, complaining of a "cyst on the lower lip" which began 5 years ago. Intraoral examination showed a painless nodule, normal color, smooth surface, and fibroelastic consistency, located on the lower lip. An excisional biopsy was performed, and histopathological examination showed a well-circumscribed, encapsulated tumor with a predominantly typical Antoni A pattern, present throughout the tumor. Immunohistochemical analysis showed positive results for S100, CD56, and CD34. The diagnosis of Schwannoma was established. The patient is undergoing follow-up, with no signs of lesion recurrence after 1 year. Schwannoma should be considered in the differential diagnosis of nodular lesions on the lip.

DIAGNOSIS, TREATMENT, AND FOLLOW-UP OF MINOR SALIVARY GLAND CANCER IN A YOUNG PATIENT

Mucoepidermoid carcinoma is the most common subtype of salivary gland malignancy and displays distinct histological features. A 17-year-old female patient, with nothing noteworthy in her medical history, was referred to our service for evaluation of a lesion located on the palate. According to the patient, the lesion appeared 4 months prior to consultation. Intraoral examination showed a purplish nodule on the right side of the hard palate measuring 1 × 1 cm, with a fibroelastic consistency and painful symptoms. Computed tomography revealed a nodular lesion with well-defined limits and absence of bone involvement. A biopsy was performed, and histopathologic examination revealed a cystic structure with mucus-secreting and epidermoid cells, characterizing a mucoepidermoid carcinoma. The patient was treated by surgical excision under general anesthesia and is being followed by our team. At 12-month follow-up, she is in good general health and has no evidence of tumor recurrence.

APPROACH TO DIAGNOSIS OF A SALIVARY GLAND TUMOR OF THE HARD PALATE: CASE REPORT

Pleomorphic adenoma is a benign salivary gland tumor commonly found in the palate. The diagnosis may be challenging once the tumor exhibits a wide range of microscopic features. A 30-year-old man with a history of attention deficit and hyperactivity was referred for evaluation of a lesion on the right side of the hard palate with 11 months of evolution. Intraoral examination revealed a painless submucosal nodule of fibroelastic consistency measuring about 1.5 × 1.0 cm. Computed tomography showed a well-defined hypodense image suggestive of benign tumor lesion, which caused slight erosion of the palatine bone. A biopsy was performed under local anesthesia and the histopathologic diagnosis was pleomorphic adenoma. The patient was then evaluated for conservative surgical excision of the tumor. Imaging and histopathologic findings are pivotal for the correct diagnosis and management of minor salivary gland tumors.

ORAL HIV-ASSOCIATED KAPOSI'S SARCOMA WITH ATYPICAL CLINICAL PRESENTATION: REPORT OF A CASE

Kaposi's sarcoma is a multifocal angioproliferative malignant neoplasm caused by human herpesvirus 8 (HHV-8) and commonly associated with acquired immunodeficiency syndrome (AIDS). A 25-year-old male patient recently diagnosed with AIDS was referred for consultation reporting multiple intraoral lesions with 2 months of evolution. Physical examination revealed diffuse multinodular purplish-red lesions of fibroelastic consistency, associated with spontaneous bleeding, affecting the whole maxillary and mandibular keratinized mucosa. Incisional biopsy was performed. Histopathologic examination revealed a mucosal fragment covered by stratified squamous epithelium exhibiting a large amount of blood vessels in the connective tissue and vascular proliferation associated with a large number of spindle-shaped neoplastic cells and red blood cell extravasation. Immunohistochemistry for HHV-8 was positive, confirming the diagnosis of Kaposi's sarcoma. After 3 months of systemic chemotherapy with liposomal doxorubicin the patient showed improvement of the oral lesions.

Adult-onset median raphe cyst of the penis

An otherwise healthy 23-year-old man presented to our male genital dermatology unit with an 8-week history of sudden postcoital appearance of a preputial growth ([figure 1A][1]). This asymptomatic lesion had...

Canine Leproid Granuloma in Mineiros City Mid-West Region of Brazil

Background: Among the bacterial dermopathy the canine leproid granuloma (CLG) is a nodular pyogranulomatous disorder that affects the skin or subcutaneous tissue mainly in the dorsal face of ear pinna, head, and extremity of members caused by Mycobacterium spp. The pathogenicity is still not well clarified regarding the causative agent, which has not yet been completely typified, but phylogenetically, it is related to Mycobacterium tilburgii, M. simiae, and M. genavense, in Brazil, by the species M. murphy. The objective of this study is to report a case of canine leproid granuloma, through cytology and histopathology, and present the therapeutic procedures until the regression of cutaneous lesion.Case: A 5-year-old Boxer breed, intac male weighing 32 kg, was assisted at the Veterinary Clinic of UNIFIMES, in Mineiros City, Mid-West Region of Brazil, GO, Brazil. The animal had 4 nodules in the ears with evolution of 30 days, with no pruritus and without previous treatment. During the physical exam, the animal had normal physiological parameters. The cutaneous lesions were characterised by papules and alopecic nodules of firm to fibroelastic consistency, with progressive increase, located in the convex face of the ears. The fine needle aspiration puncture technique (FNAP) and histopathology for a definitive diagnosis was used, allowing the differentiation between inflammatory processes, infectious and neoplastic. Furthermore, blood was collected for hemogram and biochemical analysis for the assessment of renal and hepatic functions. In cytology, the stained blades by the Diff-quick stain in the microscopic exam had elevated cellularity, with several macrophages, and bacilliform structures in the negative image. Staining was also conducted by the Ziehl-Neelsen technique, which showed the presence of alcohol-acid-resistant bacilli (AARB) inside macrophages and in the centre of granuloma. In the animal’s follow up, a punch biopsy for histopathologic was conducted. A predominance of macrophages of epithelioid appearance, which were localised in the centre of nodulations, variable quantities de-agglomerates of degenerated neutrophils, was observed. In the periphery of the lesion intense infiltrate of lymphocytes and plasmocytes was found. Based on the clinical history, in the physical exam and laboratory findings, a treatment for mycobacteriosis with oral enrofloxacin 10 mg/kg every 24 h associated to doxycycline 10 mg/kg every 24 h and rifampicin topical twice a day in the cutaneous lesions was initiated. After three months of treatment, the animal did not have collateral effects with the association of antibiotics and had a complete clinical resolution, without recurrence.Discussion: Despite that the CLG etiopathogeny is not well clarified, it is important to highlight the involvement of insects, such as flies and mosquitoes, inoculating the mycobacteria. Despite the fact that large size dogs, of breeds with short hair that are raised outdoors, have greater susceptibility to CLG and the lesions can be located specially in the face and ears, it is recommended to use complementary exams, such as cytology and histopathology, to obtain a definitive diagnosis. The CLG is a disease already reported in some regions of the Brazilian territory; however, it is believed that it is underdiagnosed, making it difficult to effectively use the therapeutic protocol.

LARGE INTRAORAL LIPOMA: A CASE REPORT

Lipomas are the most frequent mesenchymal neoplasms of the human body, being rare in the oral cavity. In the histopathological aspect, they are constituted basically of mature adipocytes. A 21-year-old man, with no comorbidities or allergies, presented with a nodule in the left mandibular region, with swelling of the chin region to the insertion region of the masseter, intraorally with grooving, ovoid-shaped, fibroelastic consistency, and coloration similar to the adjacent mucosa. Ultrasonography of the region was initially required, showing a solid, circumscribed, echogenic nodule with lobulated margins measuring 3.7 x 2.4 x 4.3 cm, compatible with lipoma, and panoramic radiographic examination showed no changes. An incisional biopsy was performed, the histologic examination revealed fragments of mature adipose tissue surrounded by a thin capsule of connective tissue, confirming the diagnosis of lipoma, so the treatment was surgical excision. The patient was followed up, with no signs of recurrence of the lesion. Lipomas are the most frequent mesenchymal neoplasms of the human body, being rare in the oral cavity. In the histopathological aspect, they are constituted basically of mature adipocytes. A 21-year-old man, with no comorbidities or allergies, presented with a nodule in the left mandibular region, with swelling of the chin region to the insertion region of the masseter, intraorally with grooving, ovoid-shaped, fibroelastic consistency, and coloration similar to the adjacent mucosa. Ultrasonography of the region was initially required, showing a solid, circumscribed, echogenic nodule with lobulated margins measuring 3.7 x 2.4 x 4.3 cm, compatible with lipoma, and panoramic radiographic examination showed no changes. An incisional biopsy was performed, the histologic examination revealed fragments of mature adipose tissue surrounded by a thin capsule of connective tissue, confirming the diagnosis of lipoma, so the treatment was surgical excision. The patient was followed up, with no signs of recurrence of the lesion.

ORAL MANIFESTATION OF HIV-ASSOCIATED LYMPHOPROLIFERATIVE DISORDER

A 38-year-old female patient, white, housekeeper, was referred to stomatology clinic for evaluation of a swelling on the left side of the mandible. According to the patient, the lesion appeared after tooth extraction performed 15 days before consultation and increased over time. Intraoral examination revealed a swelling with reddish, white and purplish areas and fibroelastic consistency. Panoramic radiography and computed tomography displayed an extensive bone destruction of mandible. A biopsy was performed, and the histopathological examination showed an intense proliferation of plasmacytoid cells, atypical mitoses and cells with nuclear hyperchromatism and cytoplasmic basophilia. Immunohistochemical staining revealed positivity for Ki-67, CD99, CD138, and lambda chain. Clinical and immunohistochemical features allowed the diagnosis of plasmablastic lymphoma. Serologic test for HIV was positive. The patient was referred to oncological treatment; however, she died 1 year later due to treatment complications. A 38-year-old female patient, white, housekeeper, was referred to stomatology clinic for evaluation of a swelling on the left side of the mandible. According to the patient, the lesion appeared after tooth extraction performed 15 days before consultation and increased over time. Intraoral examination revealed a swelling with reddish, white and purplish areas and fibroelastic consistency. Panoramic radiography and computed tomography displayed an extensive bone destruction of mandible. A biopsy was performed, and the histopathological examination showed an intense proliferation of plasmacytoid cells, atypical mitoses and cells with nuclear hyperchromatism and cytoplasmic basophilia. Immunohistochemical staining revealed positivity for Ki-67, CD99, CD138, and lambda chain. Clinical and immunohistochemical features allowed the diagnosis of plasmablastic lymphoma. Serologic test for HIV was positive. The patient was referred to oncological treatment; however, she died 1 year later due to treatment complications.

CESTODE INFECTION IN THE PAROTID LYMPH NODE

A 14-year-old patient presented with a complaint of “left ear lump,” associated with a history of fever and 1 month of evolution, and not responding to broad spectrum antimicrobials. At the echoscopic examination, there was evidence of a nodular lesion in the left parietal region, sessile, with a fibroelastic consistency. Initially, the hypotheses were salivary gland inflammation or infectious disease. Exfoliative cytology and hemogram and serum serology for HIV, rubella, cytomegalovirus, toxoplasmosis, and venereal disease research laboratory test were requested, as well as a computed tomography scan of the skull with contrast. The hematologic and serologic tests were normal; however, the cytopathology showed a nonspecific chronic inflammatory infiltrate and structures compatible with eggs and body of a developed cestode. The tomographic examination ruled out neurocysticercosis. The treatment consisted of praziquantel, ceftriaxone, and supportive medications for 15 days, followed by the surgical excision of the lesion. Currently, he is being followed up with complete remission of the lesion, without significant surgical sequelae. A 14-year-old patient presented with a complaint of “left ear lump,” associated with a history of fever and 1 month of evolution, and not responding to broad spectrum antimicrobials. At the echoscopic examination, there was evidence of a nodular lesion in the left parietal region, sessile, with a fibroelastic consistency. Initially, the hypotheses were salivary gland inflammation or infectious disease. Exfoliative cytology and hemogram and serum serology for HIV, rubella, cytomegalovirus, toxoplasmosis, and venereal disease research laboratory test were requested, as well as a computed tomography scan of the skull with contrast. The hematologic and serologic tests were normal; however, the cytopathology showed a nonspecific chronic inflammatory infiltrate and structures compatible with eggs and body of a developed cestode. The tomographic examination ruled out neurocysticercosis. The treatment consisted of praziquantel, ceftriaxone, and supportive medications for 15 days, followed by the surgical excision of the lesion. Currently, he is being followed up with complete remission of the lesion, without significant surgical sequelae.

NEURILEMMOMA OF THE BUCCAL MUCOSA: A CASE REPORT

Neurilemmoma is a benign tumor that develops from a disordered proliferation of Schwann cells. A 6-year-old female patient presented with a slow-growing submucosal nodule in the right buccal mucosa for 5 months; the child remained asymptomatic the child's mother. Clinical examination showed a palpable lesion covered by normal mucosa with fibroelastic consistency. With a diagnostic suspicion of a neural or glandular neoplasia, an incisional biopsy was performed. Histologic sections revealed a benign neural neoplasm, characterized by proliferation of spindle cells arranged diffusely or in an arrangement surrounding eosinophilic figures, in Antoni A and B patterns, confirming the diagnosis of neurilemmoma. The lesion was removed under local anesthesia. The patient remains under observation and presents no evidence of relapse 2 years after the surgery. Neurilemmoma is a benign tumor that develops from a disordered proliferation of Schwann cells. A 6-year-old female patient presented with a slow-growing submucosal nodule in the right buccal mucosa for 5 months; the child remained asymptomatic the child's mother. Clinical examination showed a palpable lesion covered by normal mucosa with fibroelastic consistency. With a diagnostic suspicion of a neural or glandular neoplasia, an incisional biopsy was performed. Histologic sections revealed a benign neural neoplasm, characterized by proliferation of spindle cells arranged diffusely or in an arrangement surrounding eosinophilic figures, in Antoni A and B patterns, confirming the diagnosis of neurilemmoma. The lesion was removed under local anesthesia. The patient remains under observation and presents no evidence of relapse 2 years after the surgery.

EXTENSIVE SPINDLE CELL CARCINOMA IN THE LIP—A CASE REPORT

Spindle cell carcinoma (SpCC) is considered a rare high malignant variant of squamous cell carcinoma (SCC) occurring predominantly in the upper aerodigestive tract. Lane tumor is a synonym for SpCC and is an uncommon poorly differentiated type of SCC comprising up to 3%. SpCC most commonly occurs in the sixth to seventh decades of life and usually affects men. A 66-year-old white patient was presenting an extensive ulcerated lesion affecting the lower lip with infiltrative fibroelastic consistency, local symptomatology, and 1 year of evolution. An incisional biopsy was performed, and the histopathologic findings were compatible with SpCC. Immunohistochemistry was also performed, which showed positivity for S-100. The association of clinical and histopathologic characteristics and the immunohistochemical analysis led to the diagnosis of SpCC. The patient was guided and referred to a head and neck surgeon for treatment.

PO 18120 - Eccrine poroma associated with a poroid hidradenoma in a large single lesion over the foot

Introduction: Eccrine poroma (EP) and poroid hidradenoma (PH) are rare benign neoplasms derived from eccrine sweat glands of the epithelium. Both are variants of poroid neoplasms and rarely become malignant. This report describes the clinical presentation, radiographic and pathological features as well as the treatment of a rare association of EP and PH in a large single lesion over the foot. Case Report: We present a 55-year-old male patient with a large soft tissue mass over the midfoot (approximately 7 cm in length and 4 cm width). It started as a hyperchromic black spot on the skin and has slowly grown over the last eight years. One year prior, pain increased significantly. There was no history of trauma, infection or other tumor in this part of the foot. In the physical exam, the tumor had well-defined edges, fibroelastic consistency and was not adherent to the surrounding soft tissue. Preoperative planning included radiographic exams: X-ray and magnetic resonance imaging (MRI). On the MRI, the tumor showed a low signal intensity on T1-weighted images, with heterogeneous high and low signal intensities on T2-weighted images. Strong contrast enhancement was observed after intravenous gadolinium administration in the base portion. The peripheral portion showed a low signal intensity without enhancement. We decided on total resection, and the procedure was performed in January of 2017. The surgical approach was a longitudinal dorsomedial incision over the first ray starting from the ankle joint to the distal third of the first metatarsal. The entire tumor was excised with clean margins and sent for anatomopathological analysis and histopathological examination. Histopathologic examination showed that the tumor was a poroid neoplasm consisting of both dermis (poroid hidradenoma) and epidermis (eccrine poroma) components. There were no features of malignancy. After 20 months of surgery, patient remains asymptomatic with no signs of recurrence of the tumor. Conclusion: Skin tumors must be born in mind in the differential diagnosis of a chronic mass in the foot. Surgical treatment for this type of tumor is curative and prevents recurrence and malignant change.

Oral Amyloidosis in A Patient with Multiple Myeloma: A Case Report

A 50-year-old male patient, being treated for multiple myeloma and renal insufficiency secondary to myeloma, presented with painful lesions in the tongue and buccal mucosa. An intra-oral examination revealed multiple nodules associated with ulcerated areas on the dorsum, side, and ventral surface of the tongue and on the buccal mucosa, with a fibroelastic consistency and reddish and purple appearance. The patient had severe thrombocytopenia and anemia. The diagnostic hypotheses were amyloidosis and trauma, and incisional biopsy was performed. Histological sections stained with hematoxylin-eosin revealed eosinophilic material in the stromal tissue, and histological sections stained with Congo red revealed amyloid deposits, confirming amyloidosis. The main lesions were removed and a silicone device was constructed to minimize the pain and trauma. Local hygiene care and low-level laser therapy in the oral lesions were administered. The disease progressed, associated with other complications, and the patient died 2 months after the diagnosis.

PHLEBOTHROMBOSIS ON THE LOWER LIP

Phlebothrombosis, or venous thrombosis, is the occlusion of a segment or whole vein because of the formation of a thrombus. It can be caused by systemic change, vascular malformation, vein damage, or the use of predisposing drugs. Herein we report a case of a 47-year-old female patient that presented with a bluish nodule, of fibroelastic consistency, 4 mm diameter, with regular and clear limits outline, located on the left side of the lower lip. The diagnostic hypothesis was of hemangioma. An incisional biopsy was performed and histopathologic analysis detected multiple dilated and congested blood vessels, as well as the presence of a thrombus with areas presenting erythrocytes and fibrin and other areas presenting fibroblasts and blood capillaries. Based on clinical and microscopic features, the diagnosis established was phlebothrombosis or venous thrombosis. Although uncommon in the oral cavity, the phlebothrombosis should be considered as a differential diagnosis of other vascular lesions.

SURGICAL TREATMENT OF GRANULOMA GRAVIDARUM IN THE TONGUE: CASE REPORT

Herein we report on a case of pyogenic granuloma in a pregnant women, so called granuloma gravidarum. A 40-year-old female patient presented to the oral surgery service at her 37th week of pregnancy complaining of local pain and dysphagia. The lesion had 4 months of evolution, and was caused by trauma of the tongue by a fractured tooth restoration of element 36. Clinical examination revealed an exophytic, pedicled of fibro-elastic consistency, reddish with whitish areas, bleeding in the left side edge of the tongue, approximately 1.5 cm diameter in the largest dimension. Excisional biopsy was performed and all tissue was submitted to histopathologic examination. Microscopic examination confirmed the diagnosis of pyogenic granuloma. The patient remains under observation after 6 months without recurrence.

Granular Cell Tumor in a Child: Case Report

Granular cell tumor is a slow-growing, benign neoplasm that most often affects women between 40 and 60 years of age, being considered rare in children. Clinically, it presents as a stiff submucosal nodule that is usually painless. A 9-year-old white female sought dental care, complaining of a painless, progressive swelling on the dorsum of the tongue that had first appeared 6 months earlier. Intraoral examination revealed a sessile nodular lesion, with a fibroelastic consistency, measuring 1.2 × 0.4 cm. An incisional biopsy was performed, and the histopathological analysis showed a non-encapsulated benign neoplasm, composed of groups of polygonal cells with normochromatic or slightly hyperchromatic egg-shaped nuclei and granular eosinophilic cytoplasm. Narrow muscle strips intercepted those cell groups, constituting a lobular arrangement. The final diagnosis was granular cell tumor. The patient underwent surgical excision of the lesion under general anesthesia and is still being followed-up.

Hyperthyroidism Due to Papillary Thyroid Carcinoma Associated with Ductal Breast Carcinoma

Thyroid tumors are usually associated with euthyroidism, and hyper functioning tumors are rare. There are few reports of carcinomas associated with hyperthyroidism. The aim of this study is to describe a case of hyper functioning papillary carcinoma associated with breast carcinoma. We present a 46-year-old woman that was referred for investigation of thyroid and breast nodules detected by routine ultrasound. She presented with hyperthyroidism and enlarged left thyroid lobe with fibroelastic consistency. Investigation demonstrated papillary carcinoma with follicular hyperactivity and invasive ductal carcinoma of the breast. The patient developed metastases 6 months later and died. This study demonstrates that hot thyroid nodules may harbor malignant tumors and should be punctured. The association with breast adenocarcinoma and the unfavorable outcome suggest higher aggressiveness of this tumor in the presence of hyperthyroidism.

Vulvar Metastasis From Bilateral Lobular Breast Carcinoma

INTRODUCTION: The invasive lobular carcinoma is the second most frequent pathological type of breast cancer, accounting for about 5-10% of breast carcinomas. Recent studies suggest an increase in incidence in relation to invasive ductal carcinoma, especially in women over age 50. The CLI has characteristic patterns of metastasis, showing the most commonly bilateral and metastases to peritoneum, gastrointestinal tract, gynecological organs, bone marrow and leptomeninges. The case reported below refers to a patient treated at the Hospital Aristides Maltez - BA, in 2002. REPORT: C. L. S. , 77 years old woman, sent to Mastology department by the Gynecology’s sector from the Hospital Aristides Maltez on 03/09/2010, whose main complaint was a lump in the vulva for 03 years. The patient had noted a small lump in the vulva for about 03 years, with faster growth in the last 06 months. Vulvar examination showed bulging of the right labia majora with almost complete erasure of the small ipsilateral lip. Hard and irregular mass of about 2.5 x2, 0cm in the right labium, which bulged the vaginal opening. We performed an incisional biopsy of that lesion which was consistent with invasive carcinoma with standard immunohistochemistry resembling ductal carcinoma of the breast. Under evaluation by mastologist there were no founds to inspection, there was a palpable dense area of about 02cm in upper outer quadrant (UOQ) right breast as well as in the union of the upper quadrants (UUQ) in the left breast, another nodule in the left breast measuring 01 cm fibroelastic consistency in UOQ. In the left axilla there was a lymph node measuring 01 cm with fibroelastic consistency. There was no nipple discharge. Mammography showed focal asymmetry in right breast union of lower quadrants (ULQ), Bi-Rads 0. Left breast presenting benign vascular calcifications, Bi-Rads 2. Ultrasound showed a heterogeneous hypoechoic poorly delimited area, measuring about 13. 3 x 6, 7mm, which may correspond to solid nodule in the right breast. The left breast showed a hypoechoic heterogeneous area in UUQ, measuring 10. 3 x7, 5mm. We performed core needle biopsy of palpable areas, the result was compatible with invasive lobular carcinoma in both breasts. The staging tests were normal, except for the chest x-ray showed diffuse interstitial infiltrate predominating in lung bases. The patient died before starting treatment due to respiratory complications. DISCUSSION: This case is relevant to show an unusual site for metastasis from infiltrating lobular carcinoma. It also shows the importance of inclusion of mammary carcinoma in the differential diagnosis of vulvar diseases.