Non-neoplastic Proliferative Processes Research Articles

Pathological conditions of the oral mucosa caused by orthodontic appliances - Integrative Review

Pathological conditions of the oral mucosa, especially non-neoplastic proliferative processes, have a high prevalence in the dental clinic and are usually caused by mechanical trauma of chronic nature with or without the association of microorganisms. Fixed and removable orthodontic appliances may be important etiological factors associated with oral mucosa injury during orthodontic treatment. Brackets, archwires, elastics, bands, and other orthodontic appliances can favor microtraumas in the oral mucosa and, when chronic, predispose the mucosa to pathophysiological changes that can culminate in the formation of a pathological condition. Non-neoplastic proliferative tissue processes, bullous lesions, inflammatory lesions, andulcerations are alterations that are commonly related to the use of orthodontic appliances and can result in various degrees of morbidity to the patient, in addition to hindering orthodontic management during treatment. The aim of this study was to discuss the relevant aspects related to the main lesions that can affect the oral mucosa due to the use of orthodontic appliancesthrough an integrative literature review.

PERIPHERAL GIANT CELLS GRANULOMA PERCEIVED AFTER TOOTH EXTRACTION: A CASE REPORT

Peripheral giant cell granuloma (PGCG) is a nonneoplastic proliferative process, usually asymptomatic and located in the gingiva or alveolar mucosa. It is caused by an irritating factor or local trauma. A 52-year-old female patient sought care, reporting an increase in volume, bleeding, and pain on chewing after extraction of tooth 44. Clinically, tumor growth with a sessile base and pink coloration, extending throughout the posterior mandibular region on the right side, was observed. Panoramic radiography and computed tomography showed an osteolytic image in the same region. An incisional biopsy was performed, followed by an anatomopathologic exam, and the diagnosis was PGCG. Surgical removal of the entire lesion was carried out in a hospital environment and the patient has been undergoing follow-up for a year, with sensitivity at the site due to the region's relationship with the lower alveolar nerve and without signs of recurrence.

NONNEOPLASTIC PROLIFERATIVE PROCESSES OF THE ORAL MUCOSA: REPORT OF TWO CASES WITH EXUBERANT CLINICAL MANIFESTATIONS

Case 1: A 35-year-old White man presenting an asymptomatic, lobulated, ulcerated, and pedunculated tumor, measuring 5.5 cm, in the right maxilla; radiographic examination showed areas of calcification. An excisional biopsy was performed, and the histopathologic diagnosis was peripheral ossifying fibroma (FOP). Case 2: A 49-year-old afrodescendant man presenting hyperplastic lesions along the maxillary alveolar ridge, with tumor formation of approximately 6.0 cm, asymptomatic, ulcerated, and bleeding. The histopathologic diagnosis was consistent with pyogenic granuloma (GP). FOP and GP are nonneoplastic proliferative processes, relatively common in dental practice, resulting from an exuberant organic response to different types of irritating agents, such as mechanical trauma, dental biofilm accumulation, and hormonal changes. Knowledge of these entities is essential because, despite benign reactive lesions, they can achieve large dimensions, making it challenging to establish a differential diagnosis with benign or malignant neoplasms.

TREATMENT OF TRAUMA-INDUCED PYOGENIC GRANULOMA WITH SCLEROSING AGENT: CASE REPORT

Pyogenic granuloma is a nonneoplastic proliferative process resulting from trauma or a low-intensity, long-lasting local irritating factor and is more frequent in females. Herein, we report a case of pyogenic granuloma in a 48-year-old female patient with a lesion in the lower lip vermilion successfully treated with the sclerosing agent ethanolamine oleate (EO). The patient reported that the lesion appeared after a trauma on the lip. The patient had been previously treated by a dermatologist who performed the surgical excision of the lesion, which later recurred. Sclerotherapy was performed in a single session with a concentration of 5% pure EO, applied in a dose of 0.3 mL. Complete regression of the lesion was observed within 2 weeks; however, the patient presented with a fibrotic papule measuring approximately 1 mm in diameter, suggestive of a hypertrophic scar. The lesion was removed because of aesthetic complaints presented by the patient. Histopathologic analysis confirmed the clinical hypothesis.

SYNCHRONOUS TELECONSULTATION IN ORAL MEDICINE

Objective: To assess the feasibility and accuracy of synchronous teleconsultation in oral medicine. Study Design: Individuals referred for specialized care due to oral lesions were evaluated in person by a general dentist who took photographs of the lesions with a smartphone. The images were sent through WhatsApp application to an oral medicine specialist, with whom a video call was initiated on the same instant messaging application. After interviewing the patient, the specialist gave a diagnostic hypothesis and suggestions for conduct. After the call ended, a second specialist, blinded to the first evaluation, assessed the oral lesion in person and suggested a diagnostic hypothesis. Results: Twenty-eight individuals, from 25 to 83 years old, presented with 32 lesions. Most participants (57%) used buses to get to the consultation and 32% of the sample was not from the city where the study was conducted. The average teleconsultation length was 11 minutes. The most frequent hypothesis was non-neoplastic proliferative processes (32%). In 81% of the cases, there was concordance between specialists regarding diagnostic hypotheses, reaching an almost perfect agreement (κ = 0.835). Conclusion: Synchronous teleconsultation can increase and accelerate diagnosis through the support of health professionals from primary care in oral lesions management.

PYOGENIC GRANULOMA IN THE FLOOR OF THE MOUTH

Pyogenic granuloma is defined as a non-neoplastic proliferative process, probably due to local irritation or trauma, with the gingiva being the site most affected (75% to 85%). A 64-year-old woman was examined, and the presence of increase in volume in the floor of the mouth on the left side, with a 2-month evolution, extending from the edentulous region of the teeth 34 to 37, painful at palpation, associated ulcer with raised borders and yellowish pseudomembrane was observed. An occlusal radiograph of the mandible was performed, and salivary calculus was not present. The clinical characteristics led to the presumptive diagnosis of squamous cell carcinoma or lymphoma, so an incisional biopsy was performed. In the histopathologic examination submucosa with numerous neoformed vessels with intense neutrophils infiltration was observed, and the final diagnosis was pyogenic granuloma. The treatment was total surgical excision of the lesion, and the patient was followed up with no recidivism.

PROLIFERATIVE PROCESS IN GINGIVA: SURPRISES IN DIAGNOSIS

Non-neoplastic proliferative processes (NNPPs) are reactive lesions frequently found in the oral cavity. Despite their benign nature, some aggressive malignant lesions may mimic those lesions. We report a case of a 64-year-old female with a chief complaint of a painful rapidly growing nodule with bleeding on palpation in the vestibular and palatal gingiva of teeth 11 and 21. Histologic examination showed nests of atypical neoplastic squamous cells infiltrating the connective tissue. Immunohistochemical analysis revealed positivity for AE1/AE3, CK5, 34 βE12, p63, p53, and Ki-67 (over 75%) but negativity for CK19. The diagnosis was gingival squamous cell carcinoma (GSCC). The patient was referred to a head and neck surgical service for proper management of the tumor. GSCC is a well-recognized malignant neoplasm of the oral cavity that may clinically mimic an NNPP. It is essential for the clinician to be aware of such a presentation to allow for proper diagnosis and treatment.

Prevalência e caracterização das lesões orais na Clínica de Estomatologia da Policlínica Piquet Carneiro – Estudo Retrospectivo de 12 anos

Objetivo: avaliar a prevalência dos principais tipos de lesões submetidas à biópsia e identificar o perfil dos pacientes atendidos no ambulatório de Estomatologia da Policlínica Piquet Carneiro (PPC/UERJ, Rio de Janeiro) no período compreendido entre 2000 e 2012. Material e Métodos: estudo transversal e retrospectivo em que prontuários de 2078 pacientes foram avaliados e dados referentes às doenças, idade, gênero, cor da pele e localização anatômica das lesões foram coletados e analisados de forma descritiva. Resultados: 69% dos pacientes (1441 casos) obtiveram o diagnóstico conclusivo através de exame histopatológico, ao passo que 31% (637 casos) obtiveram um laudo histopatológico descritivo. Dos casos com diagnóstico histopatológico conclusivo, 58% eram mulheres, 31% homens e em 11% o sexo não foi informado. A média de idade da população estudada foi de 50,63 anos e em 58% dos casos os pacientes eram leucodermas. O maior número de lesões foram as do grupo dos processos proliferativos não-neoplásicos, sendo a hiperplasia fibrosa inflamatória (30,1%) a mais prevalente. Conclusão: o perfil epidemiológico do paciente atendido no período estudado foi composto predominantemente por mulheres com mais de 50 anos de idade e a lesão oral mais prevalente foi a hiperplasia fibrosa inflamatória. Este estudo reforça a importância do papel da análise histopatológica como método auxiliar de diagnóstico e que possibilita a elaboração de estratégias específicas para prevenção e detecção precoce das doenças orais mais frequentes na população.

STUDY OF ORAL LESIONS BIOPSED AND DIAGNOSED IN STOMATOLOGY CLINIC OF THE UNIVERSITY DURING THE PERIOD FROM 2002 TO 2017

Our objective was to report the principal biopsied and diagnosed oral lesions in a stomatology clinic in a private university between 2002 and 2017. We have conducted a descriptive study in which the data from the histopathologic reports were analyzed on ExcelT and were compared to each other so as to analyze age, sex, type, and prevalence of lesions. Data from this study has been compared with data from other studies published between 2015 and 2017 dealing with the prevalence of oral lesions. We have also compared the relation between the diagnostic hypothesis (when informed by the dentist) and the definitive diagnosis (informed by the pathologist). We observed that a larger percentage coincided to each other, but 42.5% were observed to be contrary. The most incident lesion found on our results was fibrous hyperplasia, followed by the reaction lesion and nonneoplastic lesions. Gercica (2015), in her study, has also found that fibrous hyperplasia also appeared as the most recurrent lesion. Other studies have yielded fewer specific results, however, reporting the occurrence of nonneoplastic proliferative processes or soft-tissue reactive lesions. We have concluded from our analysis that fibrous hyperplasia was the main oral lesion diagnosed in patients of our clinic.

Fluorescence visualization improves the detection of oral, potentially malignant, disorders in population screening.

Scientific literature shows the great potential of fluorescence visualization (FV) in the detection of lesions in the skin and mucosa, though its use has been intermitant. Thus, the aim of this study was to compare the detection of oral cancer and oral potentially malignant disorders (OPMD) with and without the use of fluorescence visualization in population screening. During a population screening for oral cancer and OPMD, general practice dentists (GPD) performed conventional oral examination (COE) in the first year, and in the second year the FV was inserted in the oral examination. When detecting any suspicious lesion in oral mucosa either by COE or FV, patients were referred for final diagnosis by a specialist in oral medicine. Biopsy was performed in cases of high-risk lesions to confirm the diagnosis, presence of epithelial d (ED), and oral squamous cell carcinoma (OSCC). During the oral cancer prevention campaign in the first year, benign neoplasms were the oral lesions with higher diagnosis rate (26.2%), followed by non-neoplastic proliferative processes (23.8%) and potentially malignant disorders (21.4%). During the second year, with the implementation of the use of FV, OPMD were the lesions with higher diagnosis rate (37.7%). The sensitivity, specificity and accuracy for the detection of potentially malignant disorders were respectively equal to 94.4%, 96.2% and 96.1%. The detection of lesions with epithelial dysplasia for these amounts were respectively equal to 100%, 92.4% and 92.6%. FV presented high diagnostic values when used by GPD and improved the detection of OPMD in population screening. FV has potential to be used as an adjunctive method for early diagnosis of oral high-risk lesions.

Epidemiological study of lesions of the maxillofacial complex diagnosed by UNIME histopathology laboratory, Lauro de Freitas, Bahia

OBJECTIVE: Epidemiological studies have great importance for oral health as they show the prevalence of various diseases in their respective environments, in addition to being able to characterize a given population. The objective of this work is to identify the prevalence of oral lesions in dental clinics of the Faculty of Agricultural Sciences and Health of the Metropolitan Union of Education and Culture (UNIME – Lauro de Freitas) in order to characterize the epidemiological profile of this population.METHODS: The sample was composed by 434 histopathological reports of oral lesions diagnosed from 2003 to 2014, correlating them with the following variables: sex, age, type of biopsy (incisional/excisional), histopathologic diagnosis, clinical suspicion and anatomical location.REULTS: The epidemiological profile of patients affected by oral diseases had high percentage of females (62.9%), with mean age of 39 years, and the most prevalent type of biopsy was the excisional (72.81%). The data showed non-neoplastic proliferative processes as the most prevalent group of lesions (24.2%), followed by odontogenic cysts (17.5%). Lesions were most often presented in the mandible (19.6%), followed by periapex (18.89%), gum (11.75%) and jugal mucosa (9.45%).CONCLUSION: The non-neoplastic proliferative processes can be prevented with simple measures of oral health.

Atypical Presentation of Central Giant Cell Granuloma

Central giant cell granuloma is an uncommon bone pathology, characterized by a non-neoplastic proliferative process. A 67-year-old female showed, during extraoral examination, a swelling in left lower portion of the face. Intraoral examination revealed a firm swelling located in the lower gingiva on the left posterior side, measuring approximately 3 cm. The superficial mucosa was intact and had not changed color. Panoramic radiography revealed a diffuse radiolucent image with ill-defined margins in the periapical area of the premolar and first molar. Computed tomography showed a low attenuation lesion in the mandible body, destroying vestibular cortical bone and invading the medullar bone but preserving the lingual cortical plate. A biopsy was performed, and the histopathological examination revealed a giant cell lesion. Blood tests excluded hyperparathyroidism. The lesion was treated surgically. After 7 years of follow-up, there was no evidence of recurrence.

FASN expression, angiogenesis and lymphangiogenesis in central and peripheral giant cell lesions

Central giant cell lesion (CGCL) and peripheral giant cell lesion (PGCL) are non-neoplastic proliferative processes of the jaws. PGCL is a reactive process induced by irritant local factors and CGCL is an intra-osseous lesion of unknown etiology. Both lesions exhibit similar histologic features showing abundant mononuclear cells, admixed with a large number of multinucleated giant cells and a rich vascularized stroma with extravasated erythrocytes, hemosiderin deposition, and blood-filled pools. Recent studies have linked fatty acid synthase (FASN) with angiogenesis.Objective To evaluate angiogenesis and lymphangiogenesis and their relationship with FASN expression in CGCL and PGCL. Material and Methods Thirteen CGCL and 14 PGCL of the jaws were selected for immunoexpression of FASN; CD34 and CD105 (to assess blood microvessel density [MVD] and microvessel area [MVA]); and D2-40 (to assess lymphatic MVD and MVA). Results Within PGCL and CGCL, MVD-CD34 was signifcantly higher than MVD-CD10S, followed by MVD-D2-40. Moreover, a signifcantly higher number of FASN-positive multinucleated giant cells than mononuclear cells were observed. Between PGCL and CGCL, only MVD-CD34 and all MVA were signifcantly higher in PGCL. Positive correlation between MVA-CD10S with FASNpositive mononuclear cells in both lesions was observed. Conclusions Our results show both lesions exhibiting similar levels of FASN expression and neoangiogenesis, suggesting constitutive processes that regulate tissue maintenance.

Prevalence of Oral Lesions and Maxillofacial Biopsy in a Stomatology Service: Retrospective Study of 2078 Cases

The clinical examination and radiographs provide a provisional clinical diagnosis that should be confirmed by biopsy in many cases. Oral and maxillofacial lesions biopsied in Brazilian patients treated at the stomatology clinic from 2000 to 2012 were surveyed. Materials and Methods: The medical records of 2078 patients with a histopathological diagnosis of oral cavity and maxillofacial lesions were studied. The patient's clinical data were registered and evaluated retrospectively. Results: The histological findings were varied, with a total of 108 different diagnoses. Of the lesions biopsied, 104 (7.9%) were squamous cell carcinomas. The most frequent lesions biopsied were non-neoplastic proliferative processes, including in particular inflammatory fibrous hyperplasia (33.7%), pyogenic granuloma (4.5%), and peripheral ossifying fibroma (1.0%). Mucus extravasation/retention phenomenon (7.0%) and lichen planus (4.2%) were also common in our series. Conclusion: The frequency of oromaxillofacial complex lesions susceptible to histopathology study was similar to the figures reported elsewhere in the literature.

Concordância entre os diagnósticos clínico e histopatológico de lesões bucais diagnosticadas em Clínica Universitária

INTRODUÇÃO: O diagnóstico da grande variedade de lesões que ocorrem na cavidade bucal é fundamental para a prática odontológica. Na clínica, é comum o cirurgião-dentista se deparar com lesões bucais de diagnóstico duvidoso. Nessas situações, o clínico deve pensar na indicação da realização da biópsia como parte complementar - ou até mesmo conclusiva - do diagnóstico final dessas lesões bucais. A avaliação da concordância entre os diagnósticos clínico e histopatológico de lesões bucais permite analisar a acuidade e a capacidade do profissional ou acadêmico de Odontologia em realizar o diagnóstico clínico correto. OBJETIVO: O presente estudo objetivou avaliar a concordância entre os diagnósticos clínico e histopatológico de lesões bucais, diagnosticadas em clínica odontológica universitária. MÉTODO: Trata-se de um estudo analítico, de caráter retrospectivo, realizado com pacientes biopsiados e que tiveram laudos histopatológicos emitidos entre fevereiro de 2010 e julho de 2012. O programa estatístico SPSS 17.0 for Windows foi utilizado para análise dos dados. Foram conduzidas análises descritivas dos dados. A concordância entre os diagnósticos também foi medida pela estatística Kappa. RESULTADO: Obteve-se uma amostra de 125 pacientes. A média de idade foi de 48,64 anos, sendo a maioria do sexo feminino (58,4%). Os diagnósticos histopatológicos mais prevalentes foram os processos proliferativos não neoplásicos (36,6%). A concordância entre os diagnósticos clínico e histopatológico ocorreu na maioria dos pacientes (87,8%). O valor de Kappa para a concordância entre os diagnósticos foi de 0,75. CONCLUSÃO: A concordância entre os diagnósticos ocorreu na maioria dos pacientes investigados, tendo sido apresentado valor correspondente a uma concordância substancial.

Fibrous cortical defect (nonossifying fibroma) of the mandibular ramus: report of 2 cases

Fibrous cortical defect, also known as metaphyseal fibrous defect and nonossifying fibroma, among other terms, is a benign, non-neoplastic proliferative process that is relatively common in the long bones of skeletally immature adolescents. Although the lesion is thought to be a developmental abnormality or defect, the exact etiopathogenesis is largely unknown. The lesion has a limited growth potential and good treatment outcome. This process is very rare in the gnathic bones, and only a few sporadic case reports are documented. This article presents the clinicopathologic features of 2 additional cases and reviews the relevant literature in attempt to identify key features and facilitate rendering definitive diagnosis for this rare entity.

Correlation between cytologic and histopathologic diagnoses of bone lesions in dogs: a study of the diagnostic accuracy of bone cytology

The diagnostic value of cytology compared with histopathology varies by tissue, but there is little information regarding this comparison involving canine bone. The objective of this retrospective study was to compare primary pathologic processes for cytology and histopathology of canine bone lesions. We adopted a proposed standardized format for reporting studies of diagnostic accuracy. A computer search of canine medical records at the University of Minnesota Veterinary Medical Center from September 2002 through October 2006 identified 52 bone cytology samples that had incisional (IncB) and/or excisional (ExcB) biopsy performed. The primary pathologic process was determined by evaluation of original reports. Cytologic vs IncB and cytologic vs ExcB were compared pairwise for agreement. Agreement was compared for neoplastic and non-neoplastic processes using the combined IncB/ExcB data, which included all ExcB (n=21) and IncB when that was the only biopsy available (n=31). Combined data were used to determine the effect of cytology cellularity on the diagnostic correlation. The correlation in primary process between cytology and IncB was 71%, and for ExcB was 71%. For lesions with a cytologic diagnosis of neoplasia compared with the combined IncB/ExcB data set, cytology and histopathology agreed in 92% of cases, which was significantly greater (P<.0001, chi2) than the 27% for non-neoplastic processes. Cytology cellularity significantly affected rates of correlation (P=.026), with high, moderate, and poor cellularity samples having concordant primary processes in 88%, 77%, and 47% of cases, respectively. Cytologic diagnosis of neoplasia for samples collected from canine bone correlates better with histopathology than cytologic diagnosis of non-neoplastic proliferative processes or inflammation. Cytologic diagnoses from highly cellular samples are more likely to correlate with histopathology than those from less cellular samples.