RESUMO A acantose glicogênica é uma condição benigna, comumente observada durante procedimentos endoscópicos em pacientes idosos, e se apresenta como placas brancas levemente elevadas, freqüentemente encontrada no terço inferior do esôfago. Microscopicamente, a acantose glicogênica é composta por epitélio escamoso hiperplásico com depósitos de glicogênio intracitoplasmático. A acantose glicogênica extra-esofágica é extremamente rara, com apenas três relatos de casos na literatura em língua inglesa. Apresentamos um caso com uma lesão branca diagnosticada como acantose glicogênica, localizada na borda póstero-lateral esquerda da língua, afetando um paciente do sexo masculino de 56 anos. A história médica não foi contribuitória e o paciente não apresentou lesões durante o exame endoscópico do esôfago, estômago e duodeno superior. A acantose glicogênica é uma condição benigna, que deve ser incluída no diagnóstico diferencial na avaliação de lesões brancas orais. É importante também reconhecer precocemente essa condição benigna e descartar a possibilidade de outras doenças mais graves, porém mais estudos são necessários para melhor definir seu potencial de persistência ou recorrência, como observado no presente caso.

ABSTRACT Glycogenic acanthosis is a benign condition, commonly observed during endoscopic procedures in older patients, which present as slightly elevated whitish plaques often on the lower third of the oesophagus. Microscopically, glycogenic acanthosis is composed of hyperplastic squamous epithelium with intracytoplasmic glycogen deposits. The extraoesophageal glycogenic acanthosis is extremely rare, with only three case reports in the English-language literature. We report a white lesion showing glycogenic acanthosis-like features located on the left posterolateral border of the tongue, affecting a 56-year-old male patient. The medical history was non-contributory and the patient did not show any lesions during endoscopic examination of the oesophagus, stomach, and upper duodenum. Glycogenic acanthosis is a benign condition, which should be included in the differential diagnosis when assessing oral white lesions. It is important also to recognize this benign condition early and rule out the possibility of other more severe diseases, but further studies were necessary for better define their potential for persistence or recurrence, as observed in the current case.

Oral dirofilariasis is very rare with non-specific clinical manifestations. Here, we report the case of a 65-year-old South American woman with a submucosal nodule on her right buccal mucosa. The nodule was slightly tender and painful. Differential diagnoses included mesenchymal (lipoma or fibrolipoma, solitary fibrous tumor, and neurofibroma) or glandular benign tumors (pleomorphic adenoma) with secondary infections. We performed excisional biopsy. A histopathological examination revealed a dense fibrous capsule and a single female filarial worm showing double uterus appearance, neural plaque, well-developed musculature and intestinal apparatus. Dirofilariasis was diagnosed, and the patient was followed-up for 12 months without recurrence.

O linfoma de células natural killers (NK)/T extranodal é um tumor maligno agressivo com características clinicopatológicas distintas, caracterizadas por invasão e destruição vasculares, necrose proeminente, fenótipo linfocítico citotóxico e uma forte associação com o vírus Epstein-Barr. Relatamos aqui um caso de linfoma de células NK/T nasal extranodal, envolvendo o seio maxilar, assoalho de órbita, e interessantemente estendendo-se para a cavidade oral através do osso alveolar e mucosa vestibular, preservando o palato, levando a um diagnóstico inicial equivocado de doença periodontal agressiva. Ainda, nós investigamos pela primeira vez a expressão imunoistoquímica das proteínas Fatty acid sinthase (FASN) e glucose transporter 1 (GLUT-1) nesta neoplasia. FASN revelou uma forte expressão citoplasmática nas células neoplásicas, enquanto GLUT-1 e CD44 foram negativas. Estes achados sugerem que a expressão de FASN e a perda de CD44 podem estar envolvidas na patogênese do linfoma de células NK/T nasal extranodal, e que GLUT-1 não deve participar da adaptação das células tumorais ao ambiente de hipóxia. Estudos adicionais com séries maiores são necessários para confirmar nossos resultados iniciais.

Extranodal natural killer (NK)/T-cell lymphoma is an aggressive malignant tumor with distinctive clinicopathological features, characterized by vascular invasion and destruction, prominent necrosis, cytotoxic lymphocyte phenotype and a strong association with Epstein-Barr virus. Here is reported an extranodal nasal NK/T-cell lymphoma case, involving the maxillary sinus, floor of the orbit, and interestingly extending to the oral cavity through the alveolar bone and buccal mucosa, preserving the palate, leading to a primary misdiagnosis of aggressive periodontal disease. Moreover, this work investigated for the first time the immunohistochemical expression of fatty acid synthase (FASN) and glucose transporter 1 (GLUT-1) proteins in this neoplasia. FASN showed strong cytoplasmatic expression in the neoplastic cells, whereas GLUT-1 and CD44 were negative. These findings suggest that the expression of FASN and the loss of CD44 might be involved in the pathogenesis of the extranodal nasal NK/T-cell lymphoma, and that GLUT-1 may not participate in the survival adaptation of the tumor cells to the hypoxic environment. Further studies with larger series are required to confirm these initial results.

O objetivo deste estudo foi avaliar a expressão imunoistoquímica da proteína p63, receptor do fator de crescimento epidérmico (EGFR) e Notch-1 no revestimento epitelial de cistos radiculares (CR), cistos dentígeros (CD) e tumores odontogênicos queratocísticos (TOQ). Para este estudo, 35 CR, 22 CD e 17 TOQ foram utilizados. Os dados clínicos e epidemiológicos foram coletados das fichas dos pacientes arquivadas no Laboratório de Patologia Oral, Universidade de Ribeirão Preto, Brasil. Reações imunoistoquímicas contra p63, EGFR e Notch-1 foram realizadas em cortes histológicos de 3 µm. As lâminas foram avaliadas de acordo com os seguintes critérios: negativo <5% das células positivas, baixa expressão - 5%-50% das células positivas e alta expressão >50% das células positivas. Além disso, a intensidade de expressão de EGFR e Notch-1 foi também avaliada. Teste exato de Fisher e coeficiente de correlação de Spearman foram usados para análise estatística, considerando um nível de significância de 5%. Quase todos os casos demonstraram expressão de p63, EGFR e Notch-1. A expressão de p63 foi significativamente maior nos TOQ (p<0.001). Correlação positiva entre os imunomarcadores foi observada. Esses achados sugerem a participação de p63, EGFR e Notch-1 no desenvolvimento, manutenção e integridade do revestimento epitelial cístico, favorecendo a persistência das lesões. A alta expressão de p63 no TOQ sugere que ela pode estar relacionada ao comportamento biológico mais agressivo e marcada tendência a recorrência

The aim of this study was to assess the immunohistochemical expression of p63 protein, epidermal growth factor receptor (EGFR) and Notch-1 in the epithelial lining of radicular cysts (RC), dentigerous cysts (DC) and keratocystic odontogenic tumors (KOT). For this study, 35 RC, 22 DC and 17 KOT were used. The clinical and epidemiological data were collected from the patient charts filed in the Oral Pathology Laboratory, University of Ribeirão Preto, Brazil. Immunohistochemical reactions against the p63, EGFR and Notch-1 were performed in 3-µm-thick histological sections. The slides were evaluated according to the following criteria: negative: <5% of positive cells, low expression: 5-50% of positive cells, and high expression: >50% of positive cells. Moreover, the intensity of EGFR and Notch-1 expressions was also evaluated. Fisher's exact test and Spearman's correlation coefficients were used for statistical analysis, considering a significance level of 5%. Almost all cases demonstrated p63, EGFR and Notch-1 expressions. The p63 expression was significantly higher in KOT (p<0.001). Positive correlation between these immunomarkers was observed. These findings suggest the participation of p63, EGFR and Notch-1 in the development, maintenance and integrity of cystic odontogenic epithelial lining, favoring lesion persistence. The high expression of p63 in KOT suggests that it may be related to their more aggressive biological behavior and marked tendency to recurrence.

Plasma cell neoplasia is a lymphoid neoplastic proliferation of B cells. This denomination encloses multiple myeloma (MM), solitary bone plasmacytoma and extramedullary plasmacytoma. MM consists of a clonal proliferation of plasma cells based in the bone marrow, with various degrees of differentiation. Neoplastic cells usually produce great amounts of monoclonal light or heavy chains of immunoglobulin that can be detected in serum or urine. The disease is more frequently in men and the average age at diagnosis is about 60 years. The diagnosis is established by blood and urine exams and medullary biopsy. Patients may present renal failure, bone pain, fatigue, recurrent infections and nervous system dysfunction. Oral manifestations may be the first sign of MM, highlighting the importance of the dentist in the early diagnosis of the disease. Treatment involves mainly irradiation and chemotherapy and the prognosis is generally poor. This paper reports a case of a 65 years old black female who had a complaint of a painful mass in the maxilla that prompted a MM diagnosis.