Total Spontaneous Regression of a Central Giant Cell Granuloma After Incisional Biopsy: A Four-Year Follow-Up Case Report

Central giant cell granuloma (CGCG) of the jaws represents a localized and benign neoplastic lesion sometimes characterized by aggressive osteolytic proliferation. The World Health Organization defines it as an intraosseous lesion composed of cellular and dense connective tissues that contain multiple hemorrhagic foci, an aggregation of multinucleated giant cells, and occasional bone tissue trabeculae. The origin of this lesion is uncertain; however, factors such as local trauma, inflammation, intraosseous hemorrhage, and genetic abnormalities have been identified as possible causes. CGCG generally affects those younger than 30 years and occurs more frequently in women (2: 1). This lesion corresponds to approximately 7% of all benign tumors of the jaws, with prevalence in the anterior region of the jaw. Aggressive lesions are characterized by symptoms, such as pain, numbness, rapid growth, cortical perforation, root resorption, and a high recurrence rate after curettage. In contrast, nonaggressive CGCGs have a slow rate of growth, may contain sparse trabeculation, and are less likely to move teeth or cause root resorption or cortical perforation. Nonaggressive CGCGs are generally asymptomatic lesions and thus are frequently found on routine dental radiographs. Radiographically, the 2 forms of CGCG present as radiolucent, expansive, unilocular or multilocular masses with well-defined margins. The histopathology of CGCG is characterized by multinucleated giant cells, surrounded by round, oval, and spindle-shaped mononuclear cells, scattered in dense connective tissue with hemorrhagic and abundant vascularization foci. The final diagnosis is determined by histopathologic analysis of the biopsy specimen. The preferred treatment for CGCG consists of excisional biopsy, curettage with a safety margin, and partial or total resection of the affected bone. Conservative treatments include local injections of steroids, calcitonin, and antiangiogenic therapy. Drug treatment using antibiotics, painkillers, and corticosteroids and clinical and radiographic monitoring are necessary for approximately 10 days after surgery. There are only a few cases of spontaneous CGCG regression described in the literature; therefore, a detailed case report of CGCG regression in a 12-yearold boy with a 4-year follow-up is presented and compared with previous studies. (c) 2014 American Association of Oral and Maxillofacial Surgeons

Analysis of the concordance rates between core needle biopsy and surgical excision in patients with breast cancer

Objective: To evaluate whether immunohistochemical marker studies performed on core needle biopsy (CNB) specimens accurately reflect the marker status of the tumor obtained from final surgical specimen. Methods: This was a retrospective study that used the database of the Division of Mastology of the Hospital das Clinicas, Sao Paulo, Brazil. Sixty-nine patients submitted to ultrasound-guided CNB diagnosed with breast cancer were retrospectively analyzed. Immunohistochemistry (IHC) on core biopsy specimens was compared to that of excisional biopsy regarding estrogen receptor (ER), progesterone receptor (PR), human epidermal gowth factor receptor 2 gene (HER2), p53, and Ki67. The analysis of the concordance between CNB and surgical biopsy was performed using the kappa (k) coefficient (95% CI). Results: A perfect concordance between the labeling in the surgical specimens and the preoperative biopsies in p53 (k = 1.0; 95% CI: 0.76-1.0) was identified. There was an almost perfect concordance for ER (k = 0.89; 95% CI: 0.65-1.0) and a substantial concordance for PR (k = 0.70; 95% CI: 0.46-0.93). HER2 (k = 0.61; 95% CI: 0.38-0.84) and Ki-67 (k = 0.74; 95% CI: 0.58-0.98) obtained a substantial concordance this analysis. Conclusion: The results of this study indicate that the immunohistochemical analysis of ER, PR, Ki-67, and p53 from core biopsy specimens provided results that accurately reflect the marker status of the tumor. The concordance rate of HER2 was less consistent; although it produced substantial concordance, values were very close to moderate concordance.

Neoplasias de língua em cinco cães

Este trabalho tem como objetivo relatar a ocorrência de cinco casos de neoplasias de língua em cães. Os sinais clínicos mais observados foram ptialismo, halitose e hiporexia. Após biópsia excisional para exame histopatológico, os resultados revelaram dois casos de melanoma, um caso de histiocitoma, um caso de fibrossarcoma e um caso de mastocitoma grau II, sendo que neste o proprietário não autorizou qualquer forma de tratamento. O tratamento para os demais foi a glossectomia parcial e, no caso de fibrossarcoma, associou-se a quimioterapia. Dois animais apresentaram deiscência de sutura no pós-operatório, não havendo necessidade da realização de nova intervenção. em relação ao prognóstico, os pacientes com histiocitoma, fibrossarcoma e um com melanoma não apresentaram recidiva, nem metástase da doença 12 meses após a cirurgia. No outro caso de melanoma, o paciente apresentou metástase na pele e nos pulmões 30 dias após a ressecção cirúrgica.

Peripheral Ossifying Fibroma

The peripheral ossifying fibroma (POF) is a common gingival growth usually arising from the interdental papilla. The anterior maxilla is the most common location of involvement. The etiology and pathogenesis of POF remains unknown. Some investigators consider it a neoplastic process, whereas others argue that it is a reactive process; in either case, the lesion is thought to arise from cells in the periodontal ligament. Trauma or local irritants, such as dental plaque, calculus, microorganisms, masticatory force, ill-fitting dentures, and poor quality restorations, have been implicated in the etiology of POF. The recommended treatment is the excisional biopsy; however, it can leave a defect if the procedure is not followed by a subepithelial connective tissue graft. The main objective of this article was to present a clinical case of excisional biopsy of a POF followed by a subepithelial connective tissue graft to correct the defect caused by the biopsy. The biopsy defect was satisfactorily repaired, and the lesion has not recurred after 6 years of follow-up.

Oral cysticercosis: case report

Frequent in developing countries, cysticercosis is a parasitic infection that rarely involves the mouth. This study reports a case of oral cysticercosis in a 13-year-old female patient who had an asymptomatic nodule in the right labial mucosa. An excisional biopsy was carried out and the histopathologic examination revealed a cystic space containing a Taenia solium larva.

Peripheral ameloblastoma.

A case of peripheral ameloblastoma in a 57-years-old woman is presented, along with a discussion of the clinical and histological characteristics of the lesion. After clinical and radiographic examinations, and with a differential diagnosis of pyogenic granuloma, an excisional biopsy was performed and the material collected was sent for histological examination. On the basis of the histopathological diagnosis, a second operation was performed with a wide safety margin, including bone tissue, which did not show any involvement with the odontogenic neoplasm.

Periodontal plastic surgery associated with treatment for the removal of gingival overgrowth

Background: Excisional biopsies of gingival overgrowths, performed with safety margins, frequently result in mucogingival defects. These defects may produce esthetic problems and increase the chances of dentin hyperesthesia and its possibility of hindering oral hygiene. Methods: Two clinical cases are reported in which gingival overgrowths were removed by excisional biopsy, resulting in unsightly defects. The first clinical case presents an invasive approach for the treatment of a recurrent pyogenic granuloma in the anterior maxilla, and the second depicts a complete removal of a peripheral odontogenic fibroma in the posterior maxilla. In both situations, the soft-tissue defects were repaired by periodontal plastic surgery, including a laterally positioned flap and a coronally positioned flap, respectively. Results: Periodontal plastic surgery successfully restored the defects that resulted from biopsies, and no recurrence has been noticed in the 5-year postoperative follow-up period. Conclusions: The combination of biopsy and periodontal plastic surgery in a one-step procedure seems to be suitable to remove gingival overgrowths in most areas of the mouth, regardless of esthetic significance. Such procedures seem to restore gingival health, encourage healing, and create both esthetics and function in the excised area.

Congenital epulis: A rare benign tumor in the newborn

Congenital epulis (CE) of the newborn is a rare benign soft tissue tumor that presents at birth. It occurs usually as a single mass with various sizes, although some multiple lesions have also been reported. The lesion is more common in female neonates and normally affects the maxillary alveolar ridge. Rare recurrence and no malignant alteration have also been reported. This condition may interfere with respiration, feeding or adequate closure of the mouth. A decisive diagnosis is made by histopathologic analysis as other newborn lesions can be incorrectly diagnosed as CE. This article presents a case report of a female infant who presented a fibrotic mass in the primary lateral incisor and canine region of the maxillary alveolar ridge. The lesion was not causing feeding or respiratory problems. After a watchful waiting procedure and no spontaneous regression, the lesion was excised under local anesthesia and confirmed by histopathologic analysis as CE.

Granular cell tumor presenting as a tongue nodule: Two case reports

Introduction. Granular cell tumor is an uncommon neoplasm that can occur in any part of the body, including the orofacial region. The tumor is usually benign, but there are reports of cases in which the tumor shows a locally aggressive behavior, malignancy, and distant metastases. The most widely accepted hypothesis is that granular cell tumor arises from the altered metabolism of Schwann cells. The tumor is typically asymptomatic and appears as a nodule that does not exceed 3 cm. Case presentation. In case 1, a 26-year-old Caucasian man was seen at the Oral Medicine out-patient clinic of the São José dos Campos Dental School, Universidade Estadual Paulista, with a 'small blister on the tongue', which he had noted approximately three years ago. The nodule was located on the dorsum of the tongue, measured about 1.5 cm in diameter, and was not tender to palpation. Treatment consisted of an excisional biopsy performed on the basis of the diagnostic hypothesis of granular cell tumor, which was confirmed by microscopic analysis. In case 2, a 31-year-old Caucasian woman attended the out-patient clinic of the São José dos Campos Dental School, Universidade Estadual Paulista, with a five-year history of a 'painful lump on the tongue'. Intra-oral examination revealed the presence of a nodular lesion measuring approximately 0.8 cm in diameter, which was located deep in the submucosa of the right lateral margin of the tongue. Treatment consisted of an excisional biopsy performed on the basis of the differential diagnosis of neurofibroma and granular cell tumor. Microscopic analysis defined the final diagnosis of granular cell tumor. Conclusions: Granular cell tumor is an uncommon tumor that must be carefully diagnosed and treated correctly. © 2012 Sena Costa et al; licensee BioMed Central Ltd.

Peripheral calcifying cystic odontogenic tumour of the maxillary gingiva

Background: Odontogenic tumors are lesions that are derived from remnants of the components of the developing tooth germ. The calcifying cystic odontogenic tumor or calcifying odontogenic cyst is a benign cystic neoplasm of odontogenic origin that is characterized by an ameloblastoma-like epithelium and ghost cells. Calcifying cystic odontogenic tumor may be centrally or peripherally located, and its ghost cells may exhibit calcification, as first described by Gorlin in 1962. Most peripheral calcifying cystic odontogenic tumors are located in the anterior gingiva of the mandible or maxilla. Case presentation. Authors report a rare case of a peripheral calcifying cystic odontogenic tumor of the maxillary gingiva. A 39-year-old male patient presented with a fibrous mass on the attached buccal gingiva of the upper left cuspid teeth. It was 0.7-cm-diameter, painless and it was clinically diagnosed as a peripheral ossifying fibroma. After an excisional biopsy, the diagnosis was peripheric calcifying cystic odontogenic tumor. The patient was monitored for five years following the excision, and no recurrence was detected. Conclusions: All biopsy material must be sent for histological examination. If the histological examination of gingival lesions with innocuous appearance is not performed, the frequency of peripheral calcifying cystic odontogenic tumor and other peripheral odontogenic tumors may be underestimated. © 2012 Lima et al.; licensee BioMed Central Ltd.

Keratocyst of the buccal mucosa: case report and immunohistochemical comparative study with sporadic intraosseous keratocystic odontogenic tumor

Objectives: Describe a new case of keratocyst of the buccal mucosa and compare its immunohistochemical features with 13 sporadic intraosseous keratocystic odontogenic tumors (KOT). Case Report and Study Design: A male complaining about an enlargement on the left buccal mucosa was referred to the Stomatology Clinic. Clinical examination revealed a solitary nodule posterior to the parotid papilla. An excisional biopsy was performed following clinical diagnosis of epidermoid cyst. Microscopically, the lesion was characterized by a lining of five cell layers, with columnar basal cells and a corrugated parakeratinized surface. Immunohistochemical reactions for PTCH-1, Smo, Shh, mTOR, bcl-2, Ck17, and Ck19 were performed. PTCH-1 was not expressed in the keratocyst of the buccal mucosa, but was observed in suprabasal layers of eight (61.5%) cases of sporadic intraosseous KOT. Shh, mTOR, bcl-2, Ck17, and Ck19 expression was observed in all the cases investigated. Conclusions: The morphology and immunoprofile of this lesion are similar to sporadic intraosseous KOT. © 2013 Elsevier Inc. All rights reserved.

Granuloma periférico de células gigantes: relato de caso

The peripheral giant cell granuloma (GPCG) is defined as a benign disorder of uncertain etiopathogenesis and proliferative reaction of the fibrous connective tissue or periosteum, which is characterized histologically by the presence of multinucleated giant cells. The purpose of this study is to report a case of GPCG in a 56-year-old white woman presenting a bleeding nodule on palpation, a red color with small whitish ulcerated areas, defined limits, resilient consistency, a pedicled base 2.0 cm in diameter, asymptomatic, involving the permanent lower left third molar, which presented mobility. Radiographically there was significant bone loss in this tooth region, whose initial diagnosis was pyogenic granuloma. The definitive diagnosis was obtained after excisional biopsy the microscopic examination of which identified the presence of multinucleated giant cells. The clinical postoperative follow-up revealed a favorable cicatricial repair of the operated area with no recurrence after 9 months of monitoring.

Granuloma Periférico de Células Gigantes: Relato de caso com acompanhamento de 2 anos

The peripheral giant cell granuloma (GPCG) is defined as a benign disorder of uncertain etiopathogenesis, and proliferative reaction of the fibrous connective tissue or the periosteum, which is characterized histologically by the presence of multinucleated giant cells. The purpose of this study is report a case of GPCG in a white women, with 56 years old, presenting nodule bleeding to the touch, red and white with small ulcerated areas, defined limits, resilient consistency, pedicled base with 2.0 cm diameter, asymptomatic, involving the permanent lower left third molar, that it was presented with mobility. Radiographically there was significant bone loss in this tooth region, whose initial diagnosis was pyogenic granuloma. The definitive diagnosis was obtained after excisional biopsy in which microscopic examination it was identified e presence of multinucleated giant cells. The clinical postoperative presented favorable cicatricial repairing of the operated area without recurrence after two years of monitoring.

Lymphoepithelial cyst in jugal mucosa

Mouth lymphoepithelial cyst is rare, with few cases reported in literature. The aim of this article is to describe a clinical case, focusing on clinical and diagnostic aspects, treatment and prognosis. The lesion was one year old and had developed as a fibrous nodule in the jugal mucosa of a 71-year-old leucoderma patient. Considering focal inflammatory fibrous hyperplasia, fibroma and mucocele as differential diagnosis, excisional biopsy was carried out. A cystic cavity limited by pseudostratified epithelium without projections into the conjunctive tissue, with lymphoid tissue within, was microscopically identified. Without postoperative adverse events, the one-year clinical followup confirmed the favorable prognosis of this kind of lesion.

Teaching elliptical excision skills to novice medical students: a randomized controlled study comparing low- and high-fidelity bench models

Background: The search for alternative and effective forms of training simulation is needed due to ethical and medico-legal aspects involved in training surgical skills on living patients, human cadavers and living animals. Aims : To evaluate if the bench model fidelity interferes in the acquisition of elliptical excision skills by novice medical students. Materials and Methods: Forty novice medical students were randomly assigned to 5 practice conditions with instructor-directed elliptical excision skills' training (n = 8): didactic materials (control); organic bench model (low-fidelity); ethylene-vinyl acetate bench model (low-fidelity); chicken legs' skin bench model (high-fidelity); or pig foot skin bench model (high-fidelity). Pre- and post-tests were applied. Global rating scale, effect size, and self-perceived confidence based on Likert scale were used to evaluate all elliptical excision performances. Results : The analysis showed that after training, the students practicing on bench models had better performance based on Global rating scale (all P < 0.0000) and felt more confident to perform elliptical excision skills (all P < 0.0000) when compared to the control. There was no significant difference (all P > 0.05) between the groups that trained on bench models. The magnitude of the effect (basic cutaneous surgery skills' training) was considered large (>0.80) in all measurements. Conclusion : The acquisition of elliptical excision skills after instructor-directed training on low-fidelity bench models was similar to the training on high-fidelity bench models; and there was a more substantial increase in elliptical excision performances of students that trained on all simulators compared to the learning on didactic materials.